Cervical Disc Surgery: Disc Replacement or Fusion?
The vast majority of people -- more than 90% -- with pain from cervical disc disease will get better on their own over time with simple, conservative treatments. Surgery, however, may help if other treatments fail or if symptoms worsen.
Cervical disc disease is caused by an abnormality in one or more discs -- the cushions -- that lie between the neck bones (vertebrae). When a disc is damaged -- due to arthritis or an unknown cause -- it can lead to neck pain from inflammation or muscle spasm. In severe cases, pain and numbness can occur in the arms from pressure on the cervical nerve roots.
As many as 40% of people will get sciatica, or irritation of the sciatic nerve, at some point in their life. This nerve comes from either side of the lower spine and travels through the pelvis and buttocks. Then the nerve passes along the back of each upper leg before it divides at the knee into branches that go to the feet.
Anything that puts pressure on or irritates this nerve can cause pain that shoots down the back of one buttock or thigh. The sensation of pain can vary widely. Sciatica may...
Surgery for cervical disc disease typically involves removing the disc that is pinching the nerve or pressing on the spinal cord. This surgery is called a discectomy. Depending on where the disc is located, the surgeon can remove it through a small incision either in the front (anterior discectomy) or back (posterior discectomy) of the neck while you are under anesthesia. A similar technique, microdiscectomy, removes the disc through a smaller incision using a microscope or other magnifying device.
To close the space that's left when the disc is removed and restore the spine to its original height, patients have two options:
Artificial cervical disc replacement
In 2007, the FDA approved the first artificial disc, the Prestige Cervical disc, which looks and moves much like the real thing but is made of metal. Ongoing research has shown that the artificial disc can improve neck and arm pain as safely and effectively as cervical fusion while allowing for range of motion that is as good or better than with cervical fusion. People who get the artificial disc are often able to return to work more quickly as well. The surgery to replace the disc, however, does take longer and can lead to more blood loss than with cervical fusion. People who get an artificial disc can always opt for cervical fusion later. But if a patient has cervical fusion first, it's not possible to later put an artificial disc in the same spot.
Not everyone is a candidate for the artificial disc, however. Those with osteoporosis, joint disease, infection, inflammation at the site, or an allergy to stainless steel may not be candidates for disc replacement surgery.
With cervical fusion surgery, the surgeon removes the damaged disc and places a bone graft (which is taken either from the patient's hip or from a cadaver) in the space between the vertebrae. The bone graft will eventually fuse to the vertebrae above and below it. A metal plate may be screwed into the vertebrae above and below the graft to hold the bone in place while it heals and fuses with the vertebrae. Discectomy with cervical fusion can often help relieve the pain of spinal disc disease. The only caveat is that after the surgery, many people find that they lose some degree of movement in their neck.