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Cervical Disc Replacement or Fusion? Surgery for arm and neck pain, numbness, tingling and weakness from neck arthritis, disc herniation (slipped disc) and radiculopathy
Last updated Tuesday, June 09, 2009
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Considering surgeryTypes of surgery recommended The cervical stenosis can be approached from the front (anterior) or
from the back (posterior) or the patient. The decision to approach the
spine from the front is dependent upon many factors, including:
• how many levels of discs and vertebrae are involved;
• the overall alignment of the cervical spine;
• the presence of radiculopathy, myelopathy, or both;
• the presence of neck pain;
• the extent of arthritis, and more.
The
surgeon weighs these factors and the results of a full diagnostic
workup, and recommends the surgical approach and procedure.
Who should consider cervical disc replacement vs. cervical fusion? Patients with radiculopathy can initially be treated nonsurgically.
Anti-inflammatory medication, therapy, and steroid injections can treat
radiculopathy. If these treatments fail and symptoms persist, surgical
intervention (fusion or disc replacement) is generally recommended.
Proper
patient selection for a total disc replacement is essential for a
successful outcome. Not all patients are candidates for TDR. A fusion
is still more commonly performed than TDR because of selection
criteria. A total disc replacement is FDA approved for a single level
use without prior fusion. In general, if there are extensive arthritic
changes in the cervical spine, a total disc replacement may not be the
ideal treatment choice as it only addresses arthritis in the front of
the spine. If there is extensive arthritis behind the spine, it will
not be affected by a TDR.
The use of TDR for myelopathy
(spinal cord compression) is under much discussion and has not been
well defined in the scientific literature.
What happens without surgery? Radiculopathy often can resolve with nonoperative treatment modalities,
and may not require surgery. Generally, surgery is required for those
who have significant neurological deficits like severe weakness, or for
those who have had extensive non-operative treatment with minimal
improvement.Surgical options Surgical options for cervical radiculopathy include
1) Disc removal and fusion
2) Total disc replacement
3)
Posterior Foraminotomy (an incision and decompression approached from
the back of the neck- not extensively discussed in this article).
Effectiveness In the hands of an experienced surgeon, both fusion and total disc
replacement are extremely effective in relieving symptoms of nerve root
compression. After the patient has healed from the fusion procedure,
the positive effects of surgery level can last decades. The benefit at
the treated level is long lasting, however there are concerns regarding
the adjacent levels. For disc replacement, we do not have extensive
long-term data on how well these implants perform, but the 2-5 year
data is very favorable.Urgency Both fusion and disc replacement for radiculopathy are not generally
emergent procedures. Many patients may not need surgery and may recover
with exercises, anti-inflammatory medication and steroid injections.
If
the patient has severe weakness, it may be more beneficial to the
patient to surgically decompress the nerve root earlier to maximize
recovery.
Risks Any surgical procedure carries a certain amount of risk. With these
surgeries, which approach the spine from an incision on the front of
the neck, these risks include, but are not limited to, infection,
bleeding, nerve injury, and swallowing difficulty. Swallowing
difficulty is fairly common early after surgery, but is expected to
resolve over the following weeks to months
For both ACDF and
TDR, there is a small risk that the implants may lose their fixation in
the bone and not function properly. If the metal implants have
migrated, a revision surgery may be required.
Managing risk In the rare event of a complication, measures can be taken to counter
them. If an infection emerges in the early postoperative period, a
surgical cleansing of the wound can be performed.
For disc
replacement, if the implants fail to achieve fixation in the vertebra
and if they migrate, revision surgery may be required. A failed disc
replacement may have to be converted to a fusion procedure.
For
fusion, if there is a nonunion, or if the bone graft does not fuse and
the patient has symptoms because of this nonunion, a fusion can be
performed posteriorly, or the fusion can be revised from the front.
Surgery for Cervical Radiculopathy at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington If you are interested in making an appointment to discuss this procedure in Seattle, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-4288 to make an appointment. Our clinical center is located in Seattle Washington, USA
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