The surgical procedure is similar to ACDF except after discectomy, instead of putting the bone graft in disc space, an artificial disc is placed.
Anesthesia
- Surgery is performed in general anesthesia, the patient will be fully asleep.
Patient position
- Patients are positioned in the supine (lying on the back) position on the operating table.
Procedure
- A 5-centimeter horizontal incision is made in front of the neck, preferably along the skin crease (to reduce future scar). The level is confirmed with intraoperative fluoroscopy. The spine is exposed by moving aside the neck muscles, trachea, and esophagus on one side and major vessels to another side. After the disc is removed, under live x-ray imaging (fluoroscopy) for visual guidance, the artificial disc device is placed in the prepared disc space. The wound area is usually washed out with sterile water containing antibiotics. The surgical wound is closed with subcuticular self-absorbable sutures leaving a minimal scar.
The total surgery time is approximately 90 minutes.
Post-Operative Care
- After 1-2 hours of monitoring in the recovery room, patients are shifted to ward. Oral fluid intake started after 4 hours and gradually switched to a full diet. Most of the patients can stand and walk by the evening or the next morning with good pain tolerance and can be sent home accordingly in 1 day.
Home Care
- To follow proper techniques of getting in and out of bed and walking independently. The patient should walk and stay active as much as possible and can climb stairs if required. The patient should avoid excessive rotation and extension of neck activities and avoid lifting (more than 2-3 kg).
Brace
- Usually not required, however one can wear a soft neck collar if the patient finds it comfortable.
Wound Care and follow up
- Before leaving the hospital, a waterproof dressing is applied to the surgical wound, and the patient can take shower and will be called on the 5th post-op day for a dressing checkup and change of medication if needed.
Return to work
- The patient can resume light work or driving once the pain is tolerable, usually in a week after surgery. While heavy work and sports activity should be avoided for at least 6 weeks.
Complications
Cervical disc replacement is generally considered a very safe procedure, however, like any other surgery, there are several risks and complications associated with are:
Complications as common to ACDF
- Operative wound infection
- Hoarseness of voice and difficulty in swallowing
- Dural tear and CSF leakage
- Bleeding
- Implant related complication- loose screw, broken implant
- Adjacent segment disease
- Pseudoarthrosis or non-union
- Nerve root damage
- Bowel/bladder incontinence
- Deep vein thrombosis, which occurs when blood clots form in the leg
Complications specific to cervical disc replacement
- Heterotopic ossification: Bone-like material may start to grow in nearby muscles or ligaments leading to a reduction in range of neck motion
- Allergy to metal: Few reported cases have shown allergy to metal ions which shed off on regular wear and tear from artificial disc, which can cause pain or eventual implant failure.
- Artificial disc migration or hardware failure
The disadvantage of Cervical disc replacement over ACDF.
Artificial disc implant is very costly compared to implant used in ACDF.
Result of surgery
- Cervical disc replacement surgery is very safe and successful in relieving arm pain in approximately 95- 100% of patients. Various long-term studies have shown a very low incidence of secondary surgery rate at the same level or adjacent levels.
