Artificial Cervical Disc Replacement Surgery in Delhi, India

In the absence of space between the cervical vertebrae due to cervical disk degeneration or wear and tear, the cervical disc may need replacement. Cervical discs begin to collapse and tend to bulge with age. It usually affects people over 60 years or more. Some people may present more clinical symptoms from cervical disc degeneration than others. These symptoms may include:

1. Pain and stiffness in the neck

2. Headache

3. Pain that travels down through the shoulders or into the arms

4. Weakness in shoulders, arms, hands, or legs

5. Numbness or "pins and needles" like feeling in the arms

1. Cervical disc replacement should be considered when symptoms persist for more than 4 to 6 weeks, irrespective of non-surgical treatments.
2. Candidates must be in good health otherwise and healthy enough to recover from the surgery.
3. Symptoms include neck pain and pain along one arm.

Ideal candidates for cervical artificial disc replacement surgery may have the following indications:

1. Confirmed diagnosis: An MRI or CT scan imaging shows the degeneration of one or more discs; clinical symptoms should be correlated to confirm the diagnosis.

2. Radicular pain and neurological deficits: An inflamed cervical nerve root is usually associated with pain, tingling, numbness, and weakness that radiate to the arm and hand. 

3. Non-surgical treatments have been tried: Surgery would be the best choice if the symptoms don't subside within 4 to 6 weeks despite non-surgical treatments.

4. The patient's health: Candidates for cervical ADR must be in generally good health and capable of recovering well from the surgery.

Cervical ADR should be avoided in patients with any of the following:

1. Advanced spinal degeneration: Replacing a damaged disc does not help fix problems related to an ossified ligament or degenerating facet joints, such as osteoarthritis or ankylosing spondylitis. Also, artificial cervical discs require approval for use at three adjacent spinal levels as opposed to already approved for use at two adjacent spinal levels by the FDA. 

2. Weakened bones: In weak bones such as osteoporosis or a bone infection, the artificial disc may not stay intact after the surgery.

3. Prior cervical spine surgery:  Instability from a previous neck surgery may further lower the chances for cervical ADR to be successful.

4. Allergy: If the patient is allergic to any of the materials used as a prosthesis, either a different disc must be chosen, or the procedure should be avoided.

Many other potential contraindications exist, for instance, having a severe spinal deformity, an underlying medical condition that would make the surgery and/or the recovery period intolerable to the patient.

Before scheduling an appointment for the surgery, inform the surgeons about any ongoing medicines for other medical conditions. A complete body examination and imaging tests assist the operating doctors in preparing an appropriate treatment plan.

Medical Evaluation

A thorough medical and physical evaluation should be done before any surgical procedure. 

Medications

It is essential to inform the treating orthopaedic surgeon about any ongoing medications since some medicines need to be stopped or have their doses reduced before the surgery begins. The following over-the-counter medicines may cause excessive bleeding and should be stopped two weeks before surgery:

1. Non-steroidal anti-inflammatory medications or painkillers

2. A few arthritis medications

3. Blood thinners need to be stopped three days before surgery and two days after to control bleeding during the procedure.

Other Factors to be Considered are:

1. Quit smoking and use of tobacco products: Smoking increases the risk of surgical complications and detrimental effects on bones. It also prolongs the healing process.

Home Planning

Simple changes made at home can make life easier during the recovery period. It will be challenging to reach high shelves and cupboards for the first several weeks after the surgery. Hence, placing the routinely required belongings at a lower level is advised. Hiring a caregiver might help achieve simple tasks such as bathing, dressing, cooking, and laundry. If this is not feasible, staying at a rehabilitation facility may prove helpful.

Smoking and drinking should be stopped for a week before surgery until wholly healed from surgery. Following a well-regulated exercise regime and a nutritionally balanced diet can help faster recovery. Research says that people who smoke are more susceptible to suffering complications from joint replacement surgery than non-smokers. About 12 hours of fasting is recommended before the surgical procedure to avoid anaesthetic complications.

A single-level cervical artificial disc replacement surgery involves the following steps:

1. The patient is made to lie face up on the operating table. General anaesthesia is administered to put the patient to sleep and prevent pain or discomfort during the procedure.

2. A small cut is made in front of the neck, and the affected disc is removed along with any fragments of bone pressing against the nerve root.

3. The disc space is surgically restored to its normal disc height. This relieves pressure on the adjacent nerves.

4. Live x-ray imaging provides visual guidance using which the artificial disc device is placed in the prepared disc space. 

5. The incision is sewn up once the artificial disc is placed and attached to the two adjacent vertebrae (above and below).

Possible cervical disc replacement surgery complications include:

1. General surgery risks: All surgeries are accompanied by certain risks. These may include - the risk of infection, adverse reaction to medications, and excessive blood loss.

2. Difficulty speaking and swallowing: After cervical disc replacement surgery, most people experience soreness and swelling in the throat, which may cause difficulty with speaking and swallowing.

3. Heterotopic ossification: Abnormal bone-like material may outgrow the muscles or ligaments due to surgical trauma. In cases where heterotopic ossification occurs, it may lead to an unnoticeable reduced range of neck motion.

4. Artificial disc migration: The disc implant may move over time if its attachment to the bone weakens and if the device's hardware fails.

5. Pain not relieved: Pain may continue despite successful surgery.

6. Paralysis: In case there is an injury to the spinal cord, or a nerve root during the procedure, paralysis may occur in one or more limbs.

Disk replacement is a new type of spine surgery, so there is limited information on possible long-term risks and outcomes. Discussing the risks and benefits of disk replacement surgery with the operating surgeon compared with more traditional types of cervical spine surgery may help clear doubts and worries.

There is usually some pain and discomfort in the days and weeks following cervical artificial disc replacement (ADR) surgery. Most commonly, the recovering patient has some pain and soreness at the incision site at the front of the neck. Other symptoms may also be present, such as difficulty swallowing or speaking. As the recovery continues, pain and other symptoms can usually be successfully managed and go away in time.

Reviewed by Dr. Priyank Uniyal, Consultant - Spine Surgery, Spine Surgery on 02-Sep-2022

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