Cervical Disc Replacement

By Editorial Team (2)

March 6, 2021

If one or two discs in the cervical spine (neck area) are severely damaged and a patient is experiencing pain in the neck or pain radiating into an arm, due to bulging of the disc, creating pressure on the nerve that is located behind it, or if the disc is directly compressing the spinal cord, the patient may be considered for disc replacement surgery. Most often, this surgery is only recommended after non-surgical treatments, such as injections and physical therapy have failed to provide relief.

Disc Replacement Surgery Process

Disc replacement surgery is done in a process similar to the traditional discectomy and fusion procedure. The surgeon makes an incision in the front of the neck in order to remove the disc. Following the removal of the disc, the ends of the bones located just above and just below where the disc was removed are precisely prepared with special instruments. This helps ensure more accurate and more secure placement of the artificial disc. To allow for this precise preparation, the incision may have to be somewhat larger than what is needed with the traditional discectomy and fusion. There are several kinds of artificial discs now being routinely used in the United States.

Risks of Cervical Disc Replacement Surgery

There are short-term risks associated with cervical disc replacement surgery that arises during surgery and also long-term risks that can occur following the operation. Short-term risks include:

Injury to the spinal cord behind the disc that is damaged. This is approximately a 1% risk for each disc being operated on.
Damage to the nerve roots located behind the damaged disc. These can be injured in the procedure itself, or by a build-up of pressure caused by bleeding.
The blood vessels in the neck, as well as the esophagus, trachea and other structures, may be damaged.

The recurrent laryngeal nerve is located between the esophagus and the trachea. If this is injured, vocal cord paralysis could result on the affected side.

Adding all these risks together, and including the risks of anesthesia and infection which are general risks associated with most surgeries, the total risk of disc replacement surgery is approximately 1 to 2%.

Long-term risks involve the chance that the disc will not heal. This would cause a return of the patient’s pain.

Pre-Operative Advice

Two days before your disc replacement surgery, take a gentle laxative, such as colace or senna. This will help make sure your bowel is open the day you have surgery.

On the day you are scheduled for disc replacement surgery, it is important that you have nothing to eat. Do not eat anything after midnight on the night before surgery. Doctors and hospitals vary on how long prior to surgery you need to stop drinking water. You will be given pre-operative instructions that explain this. If you don’t understand something, be sure to ask your doctor.

All of your medications will be supplied by the hospital while you are a patient, so you do not need to take your medicines to the hospital. Do take along a list of the names and the doses of the medications you take.

If you have had any scans or tests, take those to the hospital with you also.

Post-Operative Care

Most likely you will wake up from disc replacement surgery in a recovery unit, known as a post-anesthesia care unit or the PACU, in some hospitals. You will spend a short time there before being moved back to the surgical floor.

Your physician may order a Patient Controlled Analgesia (PCA) pump for you to use to manage your pain. The pump is connected to your IV (intravenous) line. When you are having pain, you can activate the pump by pressing a button and a dose of pain medication will be administered through your IV. These pumps have a lockout feature that prevents overdose. PCA pumps are an effective way for patients to control post-operative pain.

Following a disc replacement surgery, the physical therapy team will start working with you. You will learn how to get safely in and out of bed and with their help, you will begin walking. The first few times you are out of bed you may feel dizzy or lightheaded. This is normal and will go away as you regain your strength. Your physician may order a collar for you to help support your neck. The therapist will help with the fitting of this, and your doctor will provide you with instructions about when and for how long you will need to wear the collar.

The nursing staff will care for your surgical incisions, re-dressing them as needed. They will also provide you with all the information and instructions you need before your discharge from the hospital.

Home Care

It is very important to your recovery that you give your body time to rest and heal for the first 6 to 8 weeks following your disc replacement surgery. Do not exercise or do any lifting during this time. You may be up and walking around while wearing the collar, according to your doctor’s instructions, but take things easy. Instead of taking one long walk, try taking several shorter walks.

You can ride in a car as a passenger, but you will not be allowed to drive for at least six weeks. You must be able to make an emergency stop. When you are riding as a passenger, be sure to make frequent stops to change position.
Flying is usually not a problem, but some of the circumstances that accompany flying can be. Do not carry luggage or try to retrieve it off the carousel. Avoid standing or sitting for extended periods. Move around as much as you can. Check with the airline prior to your flight to see what accommodations are available.

When you can return to work is something you will need to discuss with your doctor. A big part of this decision is based on what type of work you do. A person whose day is spent at a computer may be able to return to their job sooner than someone who works in the construction industry.

The nurses will instruct you on how to care for your incision before you are discharged. If you have any questions, notify your surgeon or the hospital. Typically, new dressings are applied daily until the incision is no longer draining. Once the incision is dry and no drainage is seen on the dressings, the incision can be left open to air.

Pain medications can cause constipation, so be sure to drink lots of water and eat plenty of fresh fruits and vegetables or other foods that will keep your bowels moving.

It is not likely that the disc will wear out, but the device is fairly new, so we cannot say with absolute certainty that it will not. The discs have been tested thoroughly by biomechanical methods and have not shown evidence of break down after what is equal to many years of “normal” as well as “exacerbated” use.