Cervical Disc Surgery: Disc Replacement or Fusion?
The vast majority of people -- approximately 95% -- 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.
If you have low back pain, pain doesn't stop when you go to bed at night. There's a vicious cycle of back pain and sleep problems that contribute to each other. It can be difficult to sleep well if your back hurts. And sometimes your back hurts more because you're not sleeping well. Here are some simple steps you can take to get a better night's rest, even when you have low back pain symptoms.
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. In a study of 541 patients, the artificial disc improved neck and arm pain as safely and effectively as cervical fusion, but it preserved greater range of motion. 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 shouldn't have 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 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.
Risks of Cervical Disc Surgeries
Although cervical disc surgery is generally safe, it does have a few risks, including:
Reaction to anesthesia
Chronic neck pain
Damage to the nerves, spinal cord, esophagus, or vocal cords
Failure to heal
After cervical fusion surgery, some people develop cervical disc problems above and/or below the previously affected disc. One study found that about a quarter of patients developed new cervical disc disease within 10 years of their surgery, and about 10% to 12% require an additional fusion at a different level. Researchers don't think the artificial disc will cause the same problem, but they need to investigate further to know for sure.