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Cervical Artificial Disc Replacement Surgery

What does “Cervical Artificial Disc Replacement” (C-ADR) mean?

Here is the translation of the individual words:

  1. Cervical: the area of the spine located in the neck
  2. Artificial Disc Replacement: A manmade disc designed to act similar to a human disc

Altogether, “Cervical Artificial Disc Replacement” means placing a manmade disc in the place of the original disc in the neck.

What is a Cervical Artificial Disc Replacement (C-ADR)?

  1. Prestige C-ADR made by Medtronic
  2. Prodisc-C C-ADR made by Synthes

Why is a Cervical Artificial Disc Replacement done?

A C-ADR is sometimes used instead of a fusion to replace a degenerated or herniated disc in the neck. While fusions in the neck have been done for decades, C-ADRs are still considered new devices. While many spine surgeons believe that the motion of a C-ADR is better than a fusion which provides no motion, others are still waiting to see more scientific evidence.

The initial studies which were done with C-ADRs showed them to be safe and effective. However, the long-terms studies will take potentially decades to show that they are also safe and effective in the long-term.

 How is a Cervical Artificial Disc Replacement surgery actually done?

Depending on which type of ADR is used, there are differences in how the surgery is done. However, here are some of the general steps of the surgery:

  1. An intravenous catheter (IV) is placed and antibiotics are given.
  2. This surgery is done in an Operating Room.
  3. The patient is placed on their back (supine) on the operating room table.
  4. The Anesthesia provider puts the patient to sleep under General Anesthesia.
  5. The front and sides of the neck are cleaned with a surgical antiseptic and plastic covers (drapes) are placed around the area where the cut (incision) will be made.
  6. Sometimes a small metal device is placed on the neck and an X-Ray is taken. This helps the surgeon to find out where exactly the cut (incision) should be made. The X-Ray will show the metal device and over which disc or vertebra it is located.
  7. A cut (incision) is made through the skin with a surgical knife.
  8. The first structure under the skin is the platysma muscle. This muscle is carefully split so that the deeper structures in the neck can be seen.
  9. Next, the neck fascia can be seen. Fascia is a layer of thin but tough material which separates different structures. This fascia surrounds muscles, blood vessels, organs, etc.
  10. The fascia is also split to see the structures below it.
  11. The group of deeper muscles (strap muscles) of the neck are pushed off to one side. A surgical retractor is used for this. Retractors are like “rakes” which are used to gently push structures out of the way so the surgeon can locate and see what is underneath.
  12. The swallowing tube (esophagus) is located and pushed off to the other side.
  13. The front of the neck (cervical spine) can now be seen.
  14. A disc is identified and a small needle is put into the disc.
  15. An X-Ray is taken from the side. The disc with the needle in it can be seen. The discs are now numbered to make sure that the correct disc has the needle in it.
  16. The disc is now removed with a knife and several other surgical tools. This is the most delicate part of the surgery. The surgeon has to be careful to remove all the parts of the disc which can cause a problem.
  17. Two small metal pins are place into the vertebra above and below the disc.
  18. A spreader is connected to the pins. The pins are spread to “open” or widen the space where the disc was.
  19. The space where the disc was located is measured to make sure the right size of C-ADR is chosen.
  20. Depending on what type of C-ADR is chosen, the vertebrae next to the disc may have to be prepared to accommodate it.
  21. The C-ADR is now carefully inserted. During this process, often X-Rays are taken to make sure the device is in the correct position.
  22. The main part of the surgery is now done.
  23. If used, the pins in the vertebrae are removed.
  24. The retractors are removed
  25. Sometimes a drainage tube (surgical drain) is placed to allow for any bleeding to drain out from the patient.
  26. The platysma muscle is sometimes closed with stitches (sutures).
  27. The skin is closed with small stitches (sutures).
  28. Sometimes steri-strips (butterflies) are placed over the stitches.
  29. A bandage (dressing) is placed over the wound and taped down.
  30. The patient is awoken from Anesthesia and taken to the Recovery Room.
  31. Often another X-Ray is taken in the Recovery Room to show the position of the C-ADR.

How long does a surgery like this take?

A C-ADR on one disc takes approximately 1-2 hours to complete.

  1. What is the recovery like?
  1. The patients who undergo a C-ADR surgery can either be sent home (outpatient) or admitted to the hospital. This may depend on surgeon preference, the number of C-ADRs placed, and hospital policy amongst others.
  2. The recovery may take 2-4 weeks.
  3. The surgeon usually gives the patient specific instructions on what motion to limit or avoid in the neck. One fear is that too much motion done too early in the neck could move the C-ADR out of its ideal position.
  4. Sometimes a soft neck brace is used as a reminder of the surgery and to limit the motion.
  5. The surgeon will often restrict the amount of weight a patient should lift to avoid stress on the site of the surgery.
  6. Sometimes it is recommended to take anti-inflammatory medications. This is done to avoid inflammation of the bone next to the C-ADR. Bone inflammation can cause bone spurs, which could affect the mobility of the C-ADR.
  7. The surgeon will usually take another X-Ray in a few weeks to check on the C-ADR, its position and the amount of motion it gives the patient. These X-Rays are often taken by bending forward, backwards and side to side to show the motion of the C-ADR.
  8. Once the surgeon is happy with the results of the surgery, some or all of the restrictions on movement can be lifted.
  9. The symptoms from the diseased disc (pain, numbness, weakness) often improve quickly, but can take weeks to months to reach the maximum level of improvement.

What type of benefit can patients potentially gain from a Cervical Artificial Disc Replacement?

Patient can get relief of neck and arm pain, potentially for the long term.