Transcript
A lot of patients with neck pain have seen a surgeon and been told that they need this type of surgery, and maybe think that a disc replacement surgery is better than the initial options for fusion surgery.
So first, let’s just talk about what will lead you down this pathway to see someone to consider this replacement. What problems would cause that, lead to that? What other options are there? And if you did do the surgery option, what does that recovery look like, and what is the evidence that it is helpful and safe?
First, neck surgery is a very big deal. It is usually only done for cases of severe – what we call – Radiculopathy, where you’re getting some injury to the nerves in your neck and so it may be causing pain, numbness, or weakness down your arms. A condition called Myelopathy, where you get an injury to the spinal cord so that can cause pain, weakness, numbness, tingling down the arms or the legs. A condition called spinal stenosis, where there’s just very little space around the nerves in the spinal cord so that can cause those same problems. Or the Degenerative Disc Disease, which can cause some local neck pain or irritate the nerves, again, causing all those same problems.
And so typically, again, you want to start with conservative care. So, the first line of therapy in most of these problems is going to be physical therapy or maybe some specific type of chiropractic work that can help. If that does not work, then we get into the range of injections: we have steroid injections, then we have newer regenerative medicine injections, like prolotherapy, PRP, stem cells, et cetera. And then obviously the last resort is surgery. Too often we see people go in for surgery right away, where they have not even tried all these other options beforehand. And there are a few cases where you may need to skip right to surgery. And that is when you do have that Myelopathy or your spinal cord gets injured.
I use the analogy: if your nerves are getting irritated, this room is getting smaller, so you just feel claustrophobic and you don’t have much space or room, but, you’re not getting crushed, you still can live. But, if you have the walls closing in on you and you can’t move and then get squeezed, that’s like an injury to the nerves. And that definitely needs surgery right away. So that would look like a severe weakness that’s not going away. Not able to use your arms and legs are having trouble with your bowels and the bladder, things like that – those are surgery kind of emergencies. Otherwise, surgery is just elective; it’s just another way to try to help with some of the pain and the symptoms.
Surgery Recovery: Disc Replacement v.s. Cervical Fusion
So, as far as surgery recovery, there are two main types of surgery they do for this: a regular fusion surgery where they come through the front, take out your disc – through the space between the bones – and just fuse it together.
Everybody knows that any type of fusion surgery has what we call Adjacent Segment Disease, meaning that in a year or two or more, the levels above where you get fused are going to get more stress on them. So, they’re going to get more worn out. And so they’re going to require even more treatments and more surgeries down the road. And also, if you fuse something, it doesn’t move. Our neck is meant to move. And so, the fusion limits motion, which could affect your function.
And so, the idea was that if you put artificial disc there, then you can preserve that function maybe, and maybe there would be less Adjacent Segment Disease. So, what does the research say? So, there was one study where people underwent either fusion surgery or a disc replacement surgery. About 83 people had the disc replacement, 70 had the fusion, and 54% of those patients had preserved range of motion. But that means 46% of them still lost range of motion, similar to the fusion.
25% of those patients self-fused themselves, despite the artificial disc. And the outcomes were about 50% improvement in overall pain and function. If you look at the data, though, you get a good amount of benefit for the first three months, and, after three months, you actually regress a little bit. And I suspect that’s probably because, you know, you’re healing up in those first three months, taking it easy. And then once you get cleared to get back into more activity, patients are still having some symptoms but maybe still better than the fusion.
Also, 20% of those patients that had disc replacement had to go on to have more surgery versus 10% of the fusion patients. So, you know, still not great results compared to fusion. Then it was another study that showed that, when you did have the disc replacement, if you did maintain some motion, it wasn’t normal motion.
Then there was another study that showed that, compared to fusion, you still had Adjacent Segment Disease at the same rates as a regular fusion. And as far as recovery is concerned, whenever you have surgery, it’s going to be a bigger deal. You are going to, maybe, be in a hospital for a day or so, some people can leave the same day. It’s going to be some severe pain where you’re going to need pain medicines for a few days. Typically, it’s going to be two to six weeks before you can get back to your baseline day to day activities. You’ll probably have to be out of work for at least two of those weeks, and, then, maybe by three to six months is when you can maybe start back doing things you want to do.
What Are the Treatment Options Besides Fusion and Cervical Disc Replacement?
Here at Centeno-Schultz Clinic, we were the first people to do stem cells for orthopedic uses. So we have a wide variety of regenerative treatments that can help with neck pain, general disc disease, Spinal Stenosis, Radiculopathy.
And so the mainstay of that is doing PRP- type procedures, where we can treat the joints that get irritated, the nerves, the ligaments to help provide stability, and combine that with physical therapy and or chiropractic care that can really help get similar or better outcomes to surgery without the risk, without Adjacent Segment Disease, while maintaining your motion – so improving your function, better. Stem cells are another choice that we use for some of these problems. So there are many different options out there to treat this problem besides surgery.
So if you don’t have those red flags, this would be the perfect next step if physical therapy and chiropractic care, failed. So, in summary, cervical disc replacement surgery does have some significant recovery, has significant risk, is really not that much better based on the evidence so far than the surgery it was trying to replace, or perform better than – which is fusion surgery. And again, surgery is really only needed in a few cases where you have those red flags, where the nerves actually get injured, or Myelopathy – when spinal cords get injured. Outside of that, surgery is just an option that you hopefully want to avoid, unless everything else has failed.
So, if you have this problem or any other type of orthopedic musculoskeletal problem, and you’re looking for non-surgical, non-medicine solutions, that’s what we specialize in here — diagnosing and treating those things at the Centeno-Schultz Clinic. So let us know. Take care.
References:
(1) MacDowall A, Canto Moreira N, Marques C, et al. Artificial disc replacement versus fusion in patients with cervical degenerative disc disease and radiculopathy: a randomized controlled trial with 5-year outcomes. J Neurosurg Spine. 2019;30(3):323-331. doi:10.3171/2018.9.SPINE18659
(2) Wachowski MM, Weiland J, Wagner M, Gezzi R, Kubein-Meesenburg D, Nägerl H. Kinematics of cervical segments C5/C6 in axial rotation before and after total disc arthroplasty. Eur Spine J. 2017;26(9):2425-2433. doi:10.1007/s00586-017-5073-z
(3) Yang X, Janssen T, Arts MP, Peul WC, Vleggeert-Lankamp CLA. Radiological follow-up after implanting cervical disc prosthesis in anterior discectomy: a systematic review. Spine J. 2018;18(9):1678-1693. doi:10.1016/j.spinee.2018.04.021
(4) MacDowall A, Skeppholm M, Lindhagen L, et al. Artificial disc replacement versus fusion in patients with cervical degenerative disc disease with radiculopathy: 5-year outcomes from the National Swedish Spine Register. J Neurosurg Spine. 2018;30(2):159-167. doi:10.3171/2018.7.SPINE18657 Cervical Disc Replacement Recovery
