Cervical arthroplasty is a surgery by which a degenerated or damaged disc of the cervical spine is replaced with an artificial disc. In this article we explain how this surgery, also known as cervical ADR, is performed, and in which cases it is recommended.
When a degenerated disc in the cervical spine compresses the marrow and nerves, there are different treatment options, one of which is cervical disc arthroplasty. In this surgery, a prosthetic disc that mimics the movement of a healthy natural disc is implanted to replace the damaged one.
However, before turning to surgery, at Instituto Clavel we always evaluate first the options of conservative treatments that avoid the operating room. Among these are pain relief medication, physical therapy with postural re-education, or even specific treatments for pain such as rhizolysis or infiltrations, which can provide long term pain relief.
Unfortunately, these options are not always effective. There are cases in which the disc degeneration is very advanced and the most appropriate treatment is to go directly to surgery, and there are other cases in which, despite having followed a course of conservative treatments, the pain caused by the herniated disc continues and the patient’s quality of life continues to suffer.
In what cases is cervical arthroplasty surgery recommended?
At Instituto Clavel, once we determine that surgery is necessary, our first choice is to perform arthroplasty (ADR), if the state of the patient’s spine permits it, because it is a less invasive procedure than arthrodesis or fusion surgery, and it allows the spine to preserve natural movement.
For cervical disc arthroplasty to be a possible treatment option, one of the requirements is that the patient's spine be healthy, with the exception of one or two degenerated discs. Patients on which we perform this surgery are usually between 18-60 years old.
However, there are other factors that may determine whether or not this is the appropriate surgery for the patient, so it is necessary for every patient to be evaluated in person at our center.
Symptoms of cervical disc herniation
How is cervical disc arthroplasty performed?
To perform the removal of the damaged disc, the neurosurgeon makes a small incision in the front of the neck. This is dissected to reach the cervical spine, in which we place separators that allow us to access the disc.
Then the herniated or degenerated disc is removed and the area is cleaned. In some cases, extra bone has grown behind the disc, so milling is necessary and osteophytes (bone spurs) are removed to decompress the spinal marrow and nerves. At this point, the posterior common vertebral ligament is also cleaned, because it has usually also become hypertrophied. In this way, we succeed in completely decompressing the marrow and nerves.
Once this is done, the surgeon places the artificial disc prosthesis, which is usually a disc composed of an outer shell of titanium plates, one of which is attached to the endplate of the upper adjacent vertebra and one to the endplate of the lower adjacent vertebra. In total, the operation usually takes a maximum of 45 minutes.
In this video Dr. Clavel, neurosurgeon and Director of Instituto Clavel, explains more details about the surgery.
What is recovery like after cervical disc arthroplasty?
After surgery, the patient stays in the hospital for one or two nights. During the ten days following the operation, the patient must wear a soft collar that can be removed for eating or sleeping. After ten days, the patient comes to the doctor’s office for a check-up and inspection of the healing of the incision.
At this appointment, the doctor usually recommends two or three more weeks carrying out normal life without any extra stress, before starting physical therapy. However, during these previous weeks we recommend that the patient take short walks in the morning and afternoon.
Recovery is usually a gradual process and it is normal for the patient to notice some discomfort. If the patient has an office type job, they can usually return to work after 2-3 weeks. In the case of jobs that require physical exertion, the patient will need about 6 weeks of recovery before returning to work.
However, these recommendations will vary according to the individual patient’s condition, both before and after surgery, as well as their lifestyle.
In the following link you can learn from a patient’s own words about his experience having cervical arthroplasty with us, what his recovery was like, and how his life is after having had the surgery.
Cervical disc replacement surgery (ADR): the experience of Santiago Esteve
What are the primary advantages of this surgery?
As we have said earlier, one of the main advantages of arthroplasty is that the artificial disc preserves the natural range of motion of the spine. But in addition to that, there are other benefits for the patient:
- Neither the posterior back muscles nor the medulla are manipulated, so there is hardly any danger of nerve damage.
- Lower risk of degeneration in the adjacent disc.
- The surgery does not include osteotomies, so blood loss is reduced.
- The anterior approach allows the patient to recover faster and with less pain.
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Categories: Spine treatments, Spine pathologies, Surgery