Neck pain is common in our time and many cases with particularly unpleasant consequences. In cases where the cause is disc herniation, the condition can be treated by an artificial disc replacement. But when is this surgery appropriate and what are its advantages?
Neck pain is one of the most common causes for a person to visit a spine clinic. Symptoms of the upper extremities, in addition to pain, may include a decrease in the sense of touch and, at an advanced stage, even a decrease in the strength of the fingers or the whole hand. In most cases, the cause of the symptoms is the pressure and irritation of the nerves that emanate from the spinal cord in the neck area from a disc herniation, which is the result of the degeneration of a cervical disc.
The wear of the intervertebral discs and the consequent pressure exerted on the adjacent nerve structures is treated – when it is chronic, severe, or creates a neurological deficit – by removing the degenerated disc and especially the part that presses on the nerve. An artificial cervical disc is an implant that is placed between two cervical vertebrae after surgical removal of an intervertebral disc in the neck.
The purpose is to avoid narrowing of the holes from which the nerves exit the neck, which tend to shrink after the removal of the intervertebral disc while maintaining the mobility of the cervical spine. Artificial cervical discs mimic the behavior of natural cervical discs, which, in addition to vibration dampers, are also part of the joint between two vertebrae. The advantages of this method, which has been used since the early 1990s, are still being evaluated in large clinical trials, especially in comparison with cervical vertebrae.
The vertebrae above and below the removable disc are joined by a bone graft, with a titanium cage, plate, and screws or a combination of the above. This method involves the immobilization of space and in some patients has been blamed for the development of degenerative lesions in the superior intervertebral disc after years of surgery.’
The points where the artificial cervical disc seems to have an advantage are the absence of the need to immobilize the neck with a cervical guard (collar) after the operation, with the consequent faster mobilization and return of the patient to his normal activities, as well as its long-term neck mobility. Their placement usually requires only one day of hospitalization.
There are several types of artificial disks, which, although having the same purpose, have different designs and are made of different materials: metal, usually titanium, or metal in combination with plastic polymers, such as polyurethane and polyethylene. The implants are permanent, have a long life, and do not require the use of a bone graft to be implanted in the vertebrae.
Patients for whom artificial cervical disc implantation is the most appropriate solution are those with intervertebral disc herniation with chronic pain – beyond 6 weeks -, and a neurological deficiency. Although more long-term prospective studies are needed to assess the superiority of artificial cervical disc over vertebral ligation in the development of degenerative neck disease, it is safe surgery, with minimal recovery time, while postoperatively offering an excellent quality of life.