Cervical Disc Replacements

Dr Roy Koh Kiok Miang
Consultant Neurosurgeon

What are Cervical Disc Replacements?

Cervical disc replacements are a form of surgical intervention aimed at removing damaged or degenerative cervical discs, which are located between the vertebrae in the neck, and substituting them with artificial discs. This procedure aims to maintain or improve the neck’s mobility and alleviate pain or other symptoms associated with conditions like degenerative disc disease, herniated discs, or spinal stenosis in the cervical spine.

When is Cervical Disc Replacement Needed?

Cervical disc replacement is typically considered for people who suffer from significant neck pain, arm pain, or neurological symptoms such as weakness or numbness in the arms or hands, which are attributable to degenerative disc disease or disc herniation in the cervical spine. The primary indications for cervical disc replacement include:

This condition is characterised by the breakdown of one or more intervertebral discs in the cervical spine. While disc degeneration is part of the natural ageing process, in some cases, it can lead to pain and reduced function.

A herniated disc occurs when the soft inner gel of the disc leaks out through a tear in the outer layer, potentially pressing on nearby nerves and causing pain, numbness, or weakness.

Radiculopathy involves nerve root impingement, leading to pain, numbness, or weakness radiating to the arms or hands. Myelopathy affects the spinal cord, potentially causing symptoms such as difficulty with coordination, gait disturbances, and severe functional impairments.

Benefits and Risks of Cervical Disc Replacement

Benefits

  • Preservation of Motion: Unlike spinal fusion, which locks two or more vertebrae together, cervical disc replacement allows for the preservation and sometimes improvement of neck motion. This is because the artificial disc is designed to mimic the movement of a natural disc.
  • Reduced Degeneration of Adjacent Discs: By maintaining normal neck movement, cervical disc replacement can reduce the stress on the discs above and below the surgery site, potentially lowering the risk of these discs degenerating over time.
  • Quicker Recovery: Patients often experience a quicker recovery period following cervical disc replacement compared to spinal fusion. This is partly due to the less invasive nature of the procedure and the preservation of the spine’s natural movement.
  • Decreased Need for Additional Surgery: Since cervical disc replacement can reduce the rate of adjacent segment degeneration, there may be a lower likelihood of needing additional spine surgeries in the future.

Risks

  • Prosthesis-Related Complications: There is a risk of complications related to the artificial disc, including wear and tear over time, disc dislocation, or device failure, which may necessitate additional surgery.
  • Surgical Risks: As with any surgery, there are risks of infection, bleeding, and reactions to anaesthesia. Nerve damage or other complications could potentially lead to worsening symptoms or the need for further intervention.

Preparing for Cervical Disc Replacement

Preparing for cervical disc replacement surgery involves several steps to ensure the patient is ready for the procedure and to facilitate a smooth recovery. Here are key considerations and steps involved in the preparation process:

Comprehensive Medical Evaluation

A thorough medical evaluation is conducted before the surgery. This includes a detailed review of the patient’s medical history, physical examinations, and imaging studies such as MRI or CT scans to confirm the diagnosis and plan the surgery.

Medications and Supplements

Patients must discuss their current medications and supplements with their neurosurgeon. Certain medications, especially those that can increase bleeding risk, such as aspirin and anti-inflammatory drugs, may need to be discontinued before the surgery.

Preoperative Testing

Additional tests, such as blood tests, electrocardiogram (ECG), and chest X-rays, may be required to assess the patient’s overall health status and readiness for anaesthesia and surgery.

Lifestyle Adjustments

Smokers are advised to quit smoking well in advance of the surgery, as smoking can affect blood circulation and slow down the healing process. Alcohol consumption should also be discussed, as it may interfere with medications and recovery.

Nutritional Considerations

A balanced diet can help strengthen the body before surgery. In some cases, the neurosurgeon may recommend specific nutritional supplements to improve healing.

Physical Preparation

Patients may be advised to perform specific physical exercises to strengthen the neck and upper body muscles, making post-surgery recovery smoother. However, these exercises should only be performed under the guidance of a neurosurgeon.

The Cervical Disc Replacement Procedure

Cervical disc replacement surgery is a specialised procedure designed to replace a damaged or diseased disc in the cervical spine with an artificial disc. Here is an overview of the key steps involved in the cervical disc replacement procedure:

  • Anaesthesia: The procedure begins with the administration of general anaesthesia to ensure the patient is asleep and pain-free throughout the surgery.
  • Incision: A small incision is typically made on the neck’s front (anterior) side. This approach allows the surgeon to access the cervical spine without disturbing the spinal cord or major neck muscles.
  • Disc Removal: The damaged or diseased cervical disc is carefully removed. This involves excising the disc material and any bone spurs or other structures that may be compressing nerve roots or the spinal cord.
  • Preparation of Disc Space: Once the disc is removed, the space between the vertebrae is prepared to receive the artificial disc. This preparation involves cleaning the disc space and shaping the endplates of the vertebrae to ensure a good fit for the artificial disc.
  • Implantation of the Artificial Disc: The selected artificial disc is inserted into the prepared space. The design of the artificial disc varies depending on the specific product used, but all aim to mimic the function of a natural disc.
  • Closure: After securely placing the artificial disc, the incision is closed with sutures or staples. A dressing is applied to the wound.
  • Recovery: The patient is moved to a recovery area where they are closely monitored as they wake up from anaesthesia. Pain management, including medications, is initiated to ensure comfort.

Types of Cervical Disc Prosthesis

Cervical disc prosthesis, also known as artificial cervical discs, are engineered to mimic the natural movement and function of the human spinal disc. These devices are designed to replace damaged or degenerated discs, thereby relieving pain and restoring mobility in patients with cervical disc disease. Here are some of the common types of cervical disc prosthesis:

Metal-on-Metal Discs

These prostheses consist of two metallic surfaces, typically made of cobalt-chromium or titanium alloys, that slide against each other. They are designed to replicate the natural movement of the cervical spine.

Metal-on-Biopolymer Discs

These devices feature a combination of a metallic endplate and a biopolymer (such as polyethene) core, which allows for a more natural replication of the disc’s movement. The biopolymer core is designed to simulate the cushioning effect of a natural disc.

Elastomeric Discs

Made from flexible materials, elastomeric discs aim to mimic the elasticity and compressibility of a natural disc more closely. These prostheses are designed to absorb shocks and maintain the natural curvature of the cervical spine.

Composite Discs

These are a newer generation of prostheses that combine different materials, such as ceramics, to improve durability and wear characteristics. Composite discs aim to offer the benefits of both metal-on-metal and metal-on-biopolymer designs.

Postoperative Care and Rehabilitation

Following cervical disc replacement surgery, a comprehensive postoperative care and rehabilitation plan is crucial for optimal recovery and the success of the procedure. Here are the key components of postoperative care and rehabilitation:

  • Pain Management: Patients will receive medications to manage pain and discomfort after the surgery. These may include oral pain relievers and, in some cases, muscle relaxants to ease muscle spasms.
  • Wound Care: Proper surgical site care is essential to prevent infection. Patients are instructed on how to care for their incision, including keeping it clean and dry.
  • Monitoring: Patients are closely monitored for any signs of complications, such as infection, bleeding, or neurological symptoms. Immediate medical attention is sought if any concerning signs arise.
  • Physical Therapy: Physical therapy typically begins soon after surgery, focusing initially on gentle exercises to improve neck mobility and reduce stiffness. Over time, the therapy progresses to include strength-building exercises tailored to the patient’s specific needs.
  • Activity Modification: Patients are advised on how to modify their activities to protect the surgical site while it heals. This includes guidance on safe movement techniques and restrictions on lifting heavy objects or engaging in high-impact activities.
  • Gradual Return to Daily Activities: A gradual return to daily activities is encouraged. While some activities can be resumed relatively quickly, more strenuous tasks may need to be delayed until the neck has sufficiently healed.
  • Follow-up Care: Regular follow-up appointments with the neurosurgeon are important to monitor the healing process and the integration of the artificial disc. These appointments may include imaging tests to ensure the prosthesis functions as intended.
  • Lifestyle Adjustments: Long-term success may require lifestyle adjustments, such as maintaining a healthy weight, quitting smoking (if applicable), and engaging in regular physical activity to strengthen the neck and spine.

Dr Roy Koh Kiok Miang

Consultant Neurosurgeon

Dr Roy Koh has expertise to manage a wide variety of neurosurgical and spinal problems. He was the first Neurosurgical Spine Consultant at KTPH and also performed Singapore’s first minimally invasive removal of a Spinal Tumor.

  • MBBS, National University of Singapore (NUS) in 2000
  • Basic Surgical Training in 2004
  • MRCS (Edin) and Master in Medicine(Surgery) in 2006
  • Neurosurgical Advanced Surgical training in 2008
  • Fellowship with Neurosurgical Department in Addenbrookes Hospital, Cambridge

Dr Koh has been active in pursuing his love for neurosurgery and spine surgery. He has also been an invited surgeon to places like India and visiting specialist surgeon for the Vietnamese Neurosurgical Congress in 2013, showcasing his new minimally invasive spine techniques to our neighbours.

Dr Koh is an Adjunct Assistant Professor in the Yong Loo Lin School of Medicine, where he is an MBBS examiner, and actively involved in training of the next generation of doctors.

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    Cervical Disc Replacements in Singapore

    Frequently Asked
    Questions

    How Long Is the Recovery Period After Cervical Disc Replacement Surgery?

    The recovery period after cervical disc replacement surgery generally varies, with patients typically returning to light activities within 2 to 4 weeks post-surgery. Full recovery and the ability to engage in more strenuous activities, including sports, can take up to 3 to 6 months.

    This timeline can be influenced by the person’s overall health, the complexity of the surgery, and adherence to postoperative care and rehabilitation. Regular follow-up visits with the neurosurgeon are crucial to monitor progress and address any concerns during recovery.

    Is Cervical Disc Replacement Surgery Painful?

    As with any surgical procedure, some degree of pain and discomfort is expected after cervical disc replacement surgery. However, pain management strategies, including medications, are used to control pain and ensure comfort during the recovery period.

    How Long Do Artificial Cervical Discs Last?

    The longevity of artificial cervical discs varies, but they are designed to last many years. Ongoing advancements in materials and design aim to extend the life of these prostheses. Regular follow-up appointments are important to monitor the condition of the artificial disc over time.