Cervical disc replacement for neck and arm pain
Arm pain can arise from slipped discs in the neck pinching a nerve. Slipped discs can also cause numbness or weakness and clumsiness from spinal cord compression. Seeing a spinal surgeon and having an MRI scan will diagnose the problem and enable treatment. If painkillers or injections aren’t helpful or appropriate, then an operation on the cervical spine in the neck may be needed. Generally speaking I do three types of neck operations – anterior cervical disc replacement, anterior cervical fusion and posterior cervical foraminotomy. These operations have a 90%+ chance of improving arm pain due to trapped nerves. Many patients with spinal cord compression improve significantly, with further progression of symptoms arrested, and risk of paralysis with falls prevented. The nerves are delicate structures, squashed under overgrown bone and ligament, so it is worth asking your surgeon if they use a microscope and micro-instruments to carefully remove the compression under a very magnified view.
The surgery is done under general anaesthetic. I make a small cut in a natural skin crease of the neck, that heals extremely well using absorbable sutures, and is barely visible a couple of weeks later. An overnight stay and a week or two off work is usually all that are needed. Anterior cervical surgery has small but serious risks to the structures nearby in the neck which include the carotid artery risking a stroke, gullet risking poor swallow, windpipe risking breathing problems, spinal cord risking paralysis (1 in 1000) and the nerves to the voice box risking a hoarse voice. The anterior neck structures are gently pushed to the side in natural tissue planes and pushing on the spinal cord carefully avoided to ensure these complications are not encountered.
My own preference is to use disc replacements where appropriate over one and two levels and hybridise the less common three and four level disc surgeries with fusion cages at the bottom and disc replacements at the top as the head probably acts biomechanically like a ball on a stick with most torque on the upper joints.
The image below shows a Zimmer Biomet Mobi-C disc replacement which has good evidence for superiority over fusion.
A disc replacement is not always appropriate, and a fusion may be performed in some patients. Traditionally bone was taken from the hip- which was quite painful. However, these days I use a ‘cage’ implant made either of a special plastic, or titanium alloy together with artificial bone graft granules, which probably fuse better than bone alone.
The image below shows a Stryker Solis cage, which I’ve used for a while with good results. The cage fits tightly in the cleared out disc space, so I don’t usually put a plate on top (which can irritate the gullet), and there is no need to wear a collar after surgery.
Blog written by Mr Erlick Pereira - Consultant Neurosurgeon and Spinal Surgeon
MA(Camb) BM BCh(Oxf) DM(Oxf) FRCS(Eng) FRCS(SN) SFHEA
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