Cervical Disc Surgery: Disc Replacement or Fusion?
The vast majority of people -- more than 90% -- with pain from cervical disc disease will get better on their own over time with simple, conservative treatments. Surgery, however, may help if other treatments fail or if symptoms worsen.
Cervical disc disease is caused by an abnormality in one or more discs -- the cushions -- that lie between the neck bones (vertebrae). When a disc is damaged -- due to arthritis or an unknown cause -- it can lead to neck pain from inflammation or muscle spasm. In severe cases, pain and numbness can occur in the arms from pressure on the cervical nerve roots.
Surgery for cervical disc disease typically involves removing the disc that is pinching the nerve or pressing on the spinal cord. This surgery is called a discectomy. Depending on where the disc is located, the surgeon can remove it through a small incision either in the front (anterior discectomy) or back (posterior discectomy) of the neck while you are under anesthesia. A similar technique, microdiscectomy, removes the disc through a smaller incision using a microscope or other magnifying device.
To close the space that's left when the disc is removed and restore the spine to its original height, patients have two options:
- Artificial cervical disc replacement
- Cervical fusion
In 2007, the FDA approved the first artificial disc, the Prestige Cervical disc, which looks and moves much like the real thing but is made of metal. Ongoing research has shown that the artificial disc can improve neck and arm pain as safely and effectively as cervical fusion while allowing for range of motion that is as good or better than with cervical fusion. People who get the artificial disc are often able to return to work more quickly as well. The surgery to replace the disc, however, does take longer and can lead to more blood loss than with cervical fusion. People who get an artificial disc can always opt for cervical fusion later. But if a patient has cervical fusion first, it's not possible to later put an artificial disc in the same spot.
Not everyone is a candidate for the artificial disc, however. Those with osteoporosis, joint disease, infection, inflammation at the site, or an allergy to stainless steel may not be candidates for disc replacement surgery.
With cervical fusion surgery, the surgeon removes the damaged disc and places a bone graft (which is taken either from the patient's hip or from a cadaver) in the space between the vertebrae. The bone graft will eventually fuse to the vertebrae above and below it. A metal plate may be screwed into the vertebrae above and below the graft to hold the bone in place while it heals and fuses with the vertebrae. Discectomy with cervical fusion can often help relieve the pain of spinal disc disease. The only caveat is that after the surgery, many people find that they lose some degree of movement in their neck.
Risks of Cervical Disc Surgeries
Although cervical disc surgery is generally safe, it does have a few risks, including:
- Excessive bleeding
- Reaction to anesthesia
- Chronic neck pain
- Damage to the nerves, spinal cord, esophagus, or vocal cords
- Failure to heal
After cervical fusion surgery, some people develop cervical disc problems above and/or below the previously affected disc. One study found that up to a quarter of patients developed new cervical disc disease within 10 years of their surgery, and some of those may require an additional fusion at a different level. Researchers don't think the artificial disc will cause the same problem, but they need to investigate further to know for sure.
Recovering From Cervical Disc Surgery
You should be able to get up and move around within a few hours of your cervical disc surgery, and you'll either go home from the hospital the same day or the following morning. You'll feel some pain in the area operated on, but it should ease over time.
The fusion can take anywhere from three months to a year to become solid after surgery, and you could still have some symptoms during that time. Your doctor might recommend that you wear a cervical collar to support your neck for the first four to six weeks. You may help speed the process by eating a healthy diet, getting regular exercise, and practicing good posture. Check with your surgeon to see what activity level is right for you before starting any exercise after surgery.