How Does Cervical Disc Replacement Work?

A cervical disc replacement (CDR) is a procedure that replaces a damaged disc between the vertebrae in your neck with an artificial disc. Discs are gel-like cushions that reduce friction between your vertebrae.

The goal of CDR is to improve mobility through your neck and reduce pain. CDR is also called anterior cervical disc arthroplasty (ACDR) and total disc replacement (TDR).

CDR is an alternative to stiffer spinal fusion procedures where two vertebrae are permanently connected.

Discs in our spine can become damaged with age, injury, or from certain health conditions. If a damaged disc in your neck pushes on the roots of nearby nerves, it can cause pain, numbness, or weakness down your arm.

Read on to learn more about CDRs, including who’s eligible, what to expect, and how it compares with other procedures.

The ideal candidate for CDR has a herniated disc that’s causing neurological (nervous system) symptoms or problems with movement.

A herniated disc, also called a slipped disc, is when the jelly-like core of a disc pushes through the rubbery outer layer. It can develop from a sudden injury or from disc degeneration caused by many years of use.

People who experience neurological symptoms like weakness or numbness in their arms from a cervical disc may be eligible for CDR if they:

  • have one or two damaged discs between vertebrae C3 to C7
  • are an adult with a fully developed skeleton
  • didn’t experience relief after 6 weeks of conservative treatment

Some people might not be eligible for CDR. Conditions that may make you ineligible include:

Your doctor will evaluate your condition and risk factors to decide whether CDR is a good fit for you.

The most common symptoms of cervical disc degeneration are neck pain and stiffness.

A large bundle of nerves called your brachial plexus branch off your cervical spine and control feeling and movement of your arms. A herniated disc in your neck can cause neurological symptoms in your arms if it presses on the root of these nerves.

You may experience:

  • pain
  • tingling
  • numbness
  • weakness

Spinal stenosis can also cause issues with your lower extremities, leading to walking and balance issues.

CDR is generally performed under general anesthesia so you don’t feel any pain. Your surgeon may insert a tube into your throat to help you breathe through the procedure. You’ll have monitors connected to your body to check your blood pressure, oxygen levels , and heart rate.

Your healthcare team can give you the best idea of ​​exactly what will happen during your surgery. The exact procedure can vary, but here’s what generally happens:

  1. During the procedure, you’ll lie on the operating table with your face upward. Your head and shoulders will be secured in place. Your skin will be cleaned to kill microorganisms on your skin.
  2. Your surgeon will make a 2- to 3-inch cut on the front of your neck or to one side.
  3. They will push the structures in your neck aside to access your vertebrae.
  4. Your surgeon will remove your disc and any bone spurs that are pressing on your nerves.
  5. They will insert an artificial disc into your neck.
  6. Your surgeon will close the incision with stitches and apply a dressing. You may receive a neck collar to keep your neck still, and to keep you from moving your head.

The whole procedure usually takes less than 2 to 3 hours.

A procedure called anterior cervical discectomy and fusion (ACDF) has been the gold standard for many years for relieving symptoms of cervical disc disease.

In ACDF, the surgeon removes the damaged disc and replaces it with a bone graft from somewhere else on your body, a bone graft from a donor, or an artificial disc. The surgeon then fuses your adjacent vertebrae together using metal plates and screws.

ACDF can be effective at improving symptoms caused by a damaged disc, but the fusion of vertebrae restricts motion through the neck. It can cause problems with your other vertebrae too.

According to a 2018 review of research literature, up to half of people experience degeneration of nearby discs within 5 years of the surgery.

A different 2018 review analyzed multiple high quality studies about these procedures over the last 10 years. Researchers found that single-disc CDR can cause a similar outcome as ACDF and with a lower chance of needing a second surgery.

There’s less research examining the effectiveness of CDR to replace two discs, but two-disc CDR is becoming an increasingly common procedure. There’s some evidence it may be as effective as a single disc CDR.

It’s important to note that there is a lack of long-term data about these medical devices and implants. Some people may require additional surgery to repair them. More research is needed.

For most people, it usually takes about 4 to 6 weeks to get back to daily activities after CDR.

A minority of surgery recipients, about 1.8 to 5.4 percent, will need a second operation within 5 years, reports a 2021 research review.

CDR is usually effective in reducing symptoms of a herniated disc. Researchers in one 2017 clinical trial found that the overall success rate of CDR was 60.8 percent for two-disc replacements and 55.2 percent for one-disc replacements.

For ACDF, researchers found the overall success rate was 34.2 percent for two-disc replacements and 50 percent for one-disc replacements.

A 2020 review of 139 CDR procedures found that among people who received replacements of three or four discs, patient satisfaction was 88 percent 7 years after surgery. The average improvement in the Neck Disability Index was 45.9 percent.

CDR is considered a safe procedure, but all surgeries come with a risk of complications.

General risks of having surgery include:

  • bleeding
  • infection
  • adverse reaction to anesthesia

Potential short-term complications of CDR can include:

Long-term complications can include:

  • degeneration of nearby discs (occurs in about 15 percent of cases)
  • disc implant failure
  • abnormal bone calcification around the disc replacement

CDR is a procedure that replaces a disc between the vertebrae in your neck with an artificial implant. It’s usually used to treat a herniated disc that’s causing pain or neurological or motor problems.

Research has found that CDR is a safe and effective treatment for relieving symptoms in the majority of surgery recipients.

Your doctor can help you figure out whether you make a good candidate for CDR, and prepare you for what to expect during and after your surgery.

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