Spinal Disc Replacement

Disc prolapses occur in the cervical spine in a similar way to the lumbar spine and cause neck and arm pain ( brachialgia). Successful decompression of the disc prolapse is an effective way of managing pain and this is performed through an incision in the front of the neck.

Once the disc is removed the surgeon has a choice as to what is put in its place and typically this would be either bone (fusion) or an artificial disc replacement. There are specific indications for when each is used and your surgeon should be able to inform you which is best suited for your specific condition.

Disc replacements have been used throughout the spine but the most successful outcomes are reported when used in the cervical spine. A number of implants are available but Mr Orpen uses the Baguera C disc replacement ( SpineArt) as this implant currently has good outcomes with long-term data.

The principle behind this implant is that by imitating the normal motion of the spine, the loads and stresses that would otherwise be transferred to adjacent levels are spread in a more natural pattern. This leads to less stress on the other discs and prevents them degenerating earlier than they otherwise would.

So by preserving the natural motion of the spine, degeneration in other segments is prevented and thus the need for further surgery in the future is reduced. A disc replacement is not beneficial in all instances and Mr Orpen will be able to advise you on whether you would be suitable and would benefit from this specialised form of surgery.

Baguera-C Cervical Disc Replacement

The procedure: This procedure should only be performed by a surgeon specifically trained and experienced in the indications and technique of the surgery. An operating microscope is routinely used to enhance the safety of surgery around the spinal cord.

A right sided approach is most commonly used, using an already present skin crease at the front of the neck if possible. The incision will be 3-4cm long and due to the position of the scar, with time it becomes quite well hidden in the natural creases of the neck and so is not very obvious to see.

The tissues to the front of the spine are moved out the way and as very little is actually cut during this approach, post operative pain is seldom a big problem and post operative recovery is fairly quick. The level of surgery is checked with an xray and the whole disc is removed together with spinal ligament to reveal the front of the spinal cord. The appropriate nerve is then decompressed to relieve the pain.

At this point Mr Orpen can either use a small cage to fuse the spine or a disc replacement is used. This decision is made prior to performing the surgery. Checks are made to make sure there is no bleeding and the skin is closed. No collars are used after a disc replacement operation and most patients will go home the morning after surgery as long as they feel safe to do so.

Complications

Complications are rare from this surgery, but when they do occur, some can be very serious and so are responded to very quickly. From the approach it can be seen that many important structures are retracted and so there is a theoretical chance of damage to any of these during surgery. This includes the oesophagus, trachea, carotid artery, the spinal nerves and spinal cord.

These serious complications are rare and although most patients will have the feeling of a lump in the throat for a week or two following surgery, few will experience this in the long term. For any operation there is a risk of bleeding, infection, wound problems, anaesthetic complications and neck surgery is no different.

Bleeding may present as an emergency with difficulty breathing and so patients are kept in the ward for a night. Nurses are trained to pick this up and know how to respond rapidly. Infection risk is very low and wounds are commonly barely visible after a few months in most patients.

Nearly all patients have some discomfort swallowing due to the swelling but this usually settles in 2-3 weeks. Some also have a hoarse voice due to swelling of the nerves supplying the voice box but this usually will not persist. If the latter is permanent then referral to an ENT surgeon and vocal cord physitotherpist may be necessary to check the vocal cords.

Implant related problems are fortunately rare but if displacement occurs then further surgery may be needed.

Post-Operative Care

This is different for all patients but as a guideline:

Wound - normally no sutures, just paper strips or tissue glue

Physiotherapy - the ward therapist will instruct on how to mobilise the neck but few restrictions are placed and most movements that are controlled and comfortable are allowed.

Driving - when safe and able to do an emergency stop, look in mirrors, reverse. Typically at 2-4 weeks

Work - depends on your job but commonly people return to a desk based job in two weeks and a more physical job in four weeks. No heavy tasks 2-3 months.

Mr Orpen will also be able to discuss his experience with other disc replacement designs and discuss the biomechanics of the spine.