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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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Review of the conditionCharacteristics of cervical radiculopathy Radiculopathy commonly presents as arm pain, numbness and tingling down
the arm, occasional weakness in specific muscle groups (depending on
which nerve root is affected), and neck pain. Certain neck positions
can aggravate the patient’s symptoms. When radiculopathy occurs in the
leg, it is similar to what some patients call “sciatica.”
Myelopathy
can present as changes in walking patterns, clumsy hand coordination,
in severe cases, bowel and bladder changes. Reflexes can be exaggerated
with myelopathy.
Myelopathy and radiculopathy can occur at the same time and the patient can have a combination of these symptoms.
Types Vertebral discs are the doughnut-shaped, shock-absorbing structures
that sit between each vertebrae. An injury or trauma often herniates a
disc, causing part of it to push against a nerve root.
Radiculopathy
also can be a result of advanced arthritis in the neck or upper back.
Bone-spur formation can place pressure on the nerve roots. Similarly,
tumors can emerge around the spinal canal, putting pressure on the cord.
Congenitally,
cervical stenosis presents as a naturally more narrow spinal canal.
This condition can make a person more prone to experience
radiculopathy, especially if the narrowing progresses throughout life.Similar conditions The presence of certain neurological patterns and cervical stenosis
highly suggests that the patient’s symptoms are coming from the
cervical spine. However, other neurological conditions can mimic these
symptoms. For example, if a nerve is compressed in the arm, rather than
the neck, this can mimic symptoms of radiculopathy.
Occasionally,
an electromyography (EMG) test can help differentiate the source of
symptoms. In addition to other potential sites of nerve compression,
certain metabolic conditions like multiple sclerosis can mimic symptoms
of cervical stenosis.
Incidence and risk factors The main benefit of total disc replacement over fusion is the theory
that with preserved motion, there is less likelihood of adjacent
segment degeneration. The rate of adjacent segment degeneration with a
total disc replacement is unknown. The rate of adjacent segment
degeneration with a fusion is estimated to be 26.5% in a 10 year period
following the fusion. In an often quoted study, 26.5% of people
required an additional fusion at a level adjacent to a prior fusion.
However
it is important to note that many surgeons believe that adjacent
segment degeneration is a natural progression of arthritic changes in
the spine and not necessarily a result of the fusion.
Diagnosis Radiculopathy is diagnosed with physical exam. A variety of physical
exam tests examining muscle groups, the distribution of numbness and
tingling, and the quality of reflexes allows the physician to identify
which nerves are affected.
X-rays and MRI serve to confirm
diagnoses and provide more detailed information to help determine the
appropriate surgery. Occasionally, in a clinically challenging patient,
an electromyography (EMG) and nerve-conduction testing are done to
isolate the area of nerve injury.Medications Radiculopathy (nerve root compression) can be successfully treated with
anti-inflammatory medication (ibuprofen, Naproxen), which are sold over
the counter at drugstores and groceries. These medications decrease the
inflammation and can relieve the patient’s symptoms.
If these
medications fail, a steroid injection around the affected nerve can be
performed. The steroid injection delivers a higher concentration of
anti-inflammatory medication directly around the affected nerve.
It
is important that the patient be aware of the possible side effects of
these medications, including stomach irritation, kidney problems and
bleeding. If the patient has a history of difficulty with these
medications, other treatment options should be considered.
For each medication, patients should learn possible interactions with other drugs, the recommended dosage, and the cost.Exercises Therapy can provide some relief for radiculopathy. Traction exercises
can help relieve stenosis affecting nerve roots. These exercises can
provide enough relief until the radiculopathy has resolved.Possible benefits of cervical disc replacement vs. cervical fusion With both procedures, the radiculopathy symptoms of arm pain, numbness,
tingling or weakness are relieved with the removal of the disc
herniation or bone spurs pushing against the nerve. The surgeon removes
the offending disc(s) and/or vertebral bodies, and the spine and its
nerve roots are decompressed in the front. This part of the procedure
directly takes pressure off of the spinal cord and its nerve roots.
For
a fusion, a bone graft is placed to replace the removed tissue. This
bone graft fuses the cervical spine and stabilizes the neck. The bone
may be taken from the patient’s own pelvis (autograft) or from the
tissue bank (allograft –cadaver bone). Cadaver bone has been shown to
have excellent healing rates and avoids a second incision in the
patient at the hip.
In addition to the bone graft, a small
titanium plate is placed at the vertebral levels above and below the
affected vertebra to give additional stability to the fusion after
placement of the bone graft. (Figure 1)
For a total disc
replacement, instead of bone being placed where the disc was removed, a
mobile metal implant is placed. This implant engages the bony surface
above and the bony surface below for stability. There is motion within
the implant itself. This preservation of motion normalizes stresses at
adjacent levels and theoretically may decrease the likelihood of
further arthritic changes in the cervical spine. (Figures 2 & 3)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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