Cervical Disc Replacement
Who needs it?
If one or two discs in the neck are badly damaged and causing either neck pain or pain into an arm (due to the disc bulging and compressing the nerve behind it) or if the spinal cord itself is being compressed by the disc, then the patient may be a candidate for disc replacement surgery. This surgery is typically reserved for those cases where "conservative" treatments such as physiotherapy and injections have failed to control the symptoms.
How is it done?
The surgery is done through the front of the neck, just as the traditional discectomy and fusion operation. However, once the disc has been removed, instruments are brought into the operative field to very precisely prepare the ends of the bones above and below the discectomy, to allow accurate seating of the disc prosthesis. To allow this a slightly larger incision may need to be used. Several types of prosthetic disc are now in routine use in the UK.
Several stages in accurately positioning the Bryan disc in place
A picture of the Bryan device
What are the risks?
There are short term risks, arising at the time of surgery and long term risks occurring thereafter. Short term risks include damage to the spinal cord behind the damaged disc. This is said to be around a 1% risk per disc operated upon. The nerve roots behind the disc may potentially be damaged by the surgery or bleeding causing a build up of pressure. The structures in the neck including the trachea, oesophagus and blood vessels are at risk. There is a small nerve, the recurrent laryngeal nerve, which runs in the groove between the trachea and oesophagus, which if damaged, may lead to vocal cord paralysis on the affected side. This may require treatment from a throat specialist or may resolve spontaneously.
Putting all these risks together, including the general risk of anaesthesia and infection, the total is around 1 - 2%.
The late risks include the possibility that the disc will not heal, leading to a return of the pain the patient previously suffered.
Will the disc replacement wear out?
This is unlikely, but as the device is relatively new, we cannot be absolutely sure. The biomechanical tests which have been performed on these disc have been thorough and do not show evidence of breakdown after the equivalent of many years of "normal" use and worse.
What is the recovery like?
Most patients will leave hospital within two days of the surgery and will be given a soft neck collar to wear. This is to protect the neck and to remind the patient to be careful. Activities such as lifting and carrying should be avoided for at least six weeks, to give the disc time to heal to the bone. Patients may return to non-manual work when they feel comfortable, usually at around three weeks post-operatively. Manual workers should take at least six weeks off.
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