Fusing a disc inevitably transfers
work to the adjacent discs. So, unless there is a good reason to fuse the
spine, the usual course is a disc replacement as this offers to restore and or
preserve movement at the affected level.
Disc replacement is therefore now
more common than fusion after disc removal though the evidence that it is
actually better is not as tight as you might think. Both operations are good.
Your big decision is whether to have surgery or not. If you have spent more
time thinking about replacement vs fusion your mind has been focused on the
wrong issue - though this is an important decision too.
Fusion is needed if there is
significant instability at the operated level – spondylolisthesis or if there
is a fracture as well as a prolapse.
Fusion is also used if the disc
space is already very narrow when the movement has already been lost. If the
facet joints are also worn and painful then disc replacement can make this
worse. Finally, if there are a lot of osteophytes then these have to be drilled
away. As a result of this bone work, the two vertebrae can fuse around the
replacement – this happens more often with some discs than others and may occur
as many as one in ten times.
Disc replacement is not a guarantee
of no more trouble nor does it prevent all disease in the adjacent levels. You
wore out the first disc without having had a fusion so you may also wear out
another. That said, our philosophy is to preserve and restore function where
possible.
Is there good evidence to prove disc
replacement is better? Not in the form of randomised trials. Such trials are
difficult to do, they have been flawed and to some degree inconclusive. In our
view, this reflects the difficulty of doing this kind of study. For most
patients, a logical choice can be made and where there is doubt we would opt
for disc replacement – you can fuse after if it does not work but you cannot
reverse a fusion.
Cervical
disc is a piece of specialized tissue that separates the vertebral bones of the
spinal column in the neck. Cervical disc disease is caused by an abnormality in
one or more discs. When a disc is damaged due to arthritis or an unknown cause
it can lead to neck pain from inflammation or muscle spasm. Severe pain and
numbness can occur in the arms from pressure on the cervical nerve roots. The
disc space is jacked up to its prior normal disc height to help decompress
(relieve pressure) on the nerves. In severe cases, when the patient is not
benefited from non-surgical treatments like medication or physiotherapy then
they are advised Cervical Disc Replacement Surgery.
The
Center of the disc, which is called the nucleus, is soft, springy and receives
the shock of standing, walking, running, etc. The outer ring of the disc, which
is called the annulus (Latin for ring), provides structure and strength to the
disc. Patients with cervical disc herniations are advised cervical disc
replacement, if they have not responded to non-surgical treatments like
medication or physiotherapy.In the surgery, an artificial disc replaces the
worn out or affected one and the disc space is jacked up to the normal height.
Spinal Fusion
This is usually performed with a plate and integrated cage (PCB). This is filled with recycled bone collected during the decompresion of the spine in addition to some synthetic bone supplement. Usually no additional bone needs to be taken from the pelvis. Profesional athletes involved in heavy contact sport such as rugby may wish to utilise their own pelvic bone as it is still probaly provides for the fastest and most secure fusion. Return to play is often possible at three months.
the device, filled here with synthetic bone, is ready for insertion.
This technique obliviates the need for a separate incision and the harvesting
of the patient’s bone from elsewhere, e.g. the pelvis.
After Surgery
Patients are usually able to get out of bed within an hour or two after surgery. Your surgeon may have you wear a hard or soft neck collar. If not, you will be instructed to move your neck only carefully and comfortably.Most patients leave the hospital the day after surgery and are safe to drive within a week or two. People generally get back to light work by four weeks and can do heavier work and sports within two to three months.
Outpatient physical therapy is usually prescribed only for patients who have extra pain or show significant muscle weakness and deconditioning.
Rehabilitation
At first, therapy treatments are used to help control pain and inflammation. Ice and electrical stimulation treatments are commonly used to help with these goals. Your therapist may also use massage and other hands-on treatments to ease muscle spasm and pain.
Active treatments are added slowly. These include exercises for improving heart and lung function. Walking, stationary cycling, and arm cycling are ideal cardiovascular exercises. Therapists also teach specific exercises to help tone and control the muscles that stabilize the neck and upper back.
Your therapist works with you on how to move and do activities. This form of treatment, called body mechanics, is used to help you develop new movement habits. This training helps you keep your neck in safe positions as you go about your work and daily activities. You'll learn how to keep your neck safe while you lift and carry items and as you begin to do other heavier activities.
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