In the past two decades cervical (neck) disk replacement has become a huge interest of spine research. Cervical disk replacement (CDR) now has been tested and approved for treatment of certain neck disorders such as diseased or bulging disks that cause radiculopathy or myelopathy. The first FDA approved disk replacement in the US occurred in 2007 for one level cervical disk replacements from C3-C7. Another exciting approval occurred in 2013 with the indication for two level cervical disk replacements for C3-C7. In this article we will discuss why this has become a game changer for the treatment of cervical radiculopathy.
First, what are the indications for cervical total disc replacement? Patients must meet the following criteria.
- Skeletally mature
- Clinically symptomatic cervical radiculopathy and/or myelopathy due to nerve compression C3-C7 at one-level or two adjacent levels (see clinical symptoms below)
- Intractable radiculopathy (arm pain and/or neurological deficit) with or without associated neck pain
- Myelopathy (due to abnormality localized to the level of the disk space) which is functional or pathological impairment of the spinal cord
- Failed at least 6 weeks of nonsurgical treatment or shows signs of progressively clinical deterioration
There are many advantages of CDR over a traditional fusion procedure known as anterior cervical discectomy and fusion (ACDF). The ACDF has been established surgical procedure with a well-documented safety and efficacy going back sixty plus years. However it is no secret that ACDF results in loss of motion at the levels operated on which places increased stress on adjacent levels above and below the fusion. There is documented evidence of change of adjacent level degeneration of up to 3% annually. CDR allows the surgeon to maintain the motion with the help of an artificial disk. The disk replacement preserves motion that would be taken away with a fusion procedure dropping the increased risk of adjacent level disease. No additional stress is added to the neighboring levels. This device truly has been a game changer for patients with cervical radiculopathy. CDR is not indicated for every patient but it can mean the world of difference for those that that do.
Although ACDF loses motion it maintains stability and sometimes this is preferable based on the patient at hand. There is a reason why the ACDF procedure has been around for 60+ years and that is because it is effective. The CDR procedure will never totally replace the ACDF but it does offer and additional option that should be considered in certain individuals. So to fuse or not to fuse really shouldn’t be the question but more or less two available options for patients.
About The Author: Derek N. Morrow, PA-C is a physician assistant with Prairie Spine and Pain Institute. Derek works in the clinic setting as a health care provider seeing patients. He is also utilized in the operating room as a first assist in surgery. In the clinic setting, his key function is to diagnose new patients and conduct their initial treatment. He works directly with patients to establish customized treatment programs and to monitor their progress. He also conducts history and physical evaluations for many patients. He performs many office procedures including trigger point injections, large joint injections, and bursa injections, all with the help of ultrasound guidance. He is radiologically trained, and uses his knowledge of X-ray, Ultrasound, MRI, CT, and EMG-Nerve Conduction Studies to establish a diagnosis and determine the appropriate treatment. Derek is surgically trained and plays a vital role in the procedures we perform at Prairie Spine and Pain Institute.