Cervical disc replacement is performed after an anterior cervical discectomy.

Discectomy literally means “cutting out the disc.” The surgeon reaches the damaged disc from the front (anterior) of the spine, through the throat area. By moving aside the neck muscles, trachea, and esophagus, the disc and bony vertebrae are accessed. In the neck area of the spine, an anterior approach is more convenient than a posterior (back) because the disc can be reached without disturbing the spinal cord, spinal nerves, and the strong neck muscles of the back. Depending on your particular case, one disc (single-level) or more (multi-level) may be removed.

After the disc is removed, the space between the bony vertebrae is empty. To prevent the vertebrae from collapsing and rubbing together, the surgeon fills the open disc space with a biomechanical motion device that replaces your disc. This device preserves some of the motion in your neck and theoretically protects the adjacent discs from added stress seen in fusion surgery.

Before Surgery

One or more diagnostic studies such as magnetic resonance imaging (MRI) or a CT Scan and myelogram may be necessary to diagnose the degree of herniation and/or bone spurs affecting the nerves and/or spinal cord. This valuable information is used by Dr. Kube to understand your condition so that he may perform the procedure precisely. You should arrange to have someone drive you to and from the facility. You are not permitted to eat or drink after midnight the night before surgery.

Cigarette smoking dramatically impairs bone healing. Although, your spine is not being fused, many of the disc replacement devices have bone ingrowth surfaces that help stabilize the implant long term. You should also stop taking any medications or vitamins that thin the blood. Consultation with your Internist or other treating physician regarding the cessation of the medication should occur before you discontinue any medication. They may also desire a variety of tests and labs to be done to help determine what medial risks you might have if surgery is to be performed.

Ask questions. We are here to provide you with as much information as possible so that you are able to make an informed decision and optimize outcomes and expectations.

Morning of surgery
• Shower using antibacterial soap. Dress in freshly washed, loose-fitting clothing.
• Wear flat-heeled shoes with closed backs.
• If you have instructions to take regular medication the morning of surgery, do so with small sips of water.
• Remove make-up, hairpins, contacts, body piercings, nail polish, etc.
• Leave all valuables and jewelry at home (including wedding bands).
• Bring a list of medications (prescriptions, over-the-counter, and herbal supplements) with dosages and the times of day usually taken.
• Bring a list of allergies to medication or foods.
• If you have a cold, fever or some other illness the day before surgery, please call your surgeons office.

During Surgery

You will lie on your back on the operative table and be given anesthesia. A small incision will be made anteriorly on your neck. With the aid of an X-ray, the surgeon locates the affected vertebra and disc. To remove the damaged disc, the vertebrae above and below the disc must be held apart. Your surgeon first inserts a pin into the body of each vertebra above and below the disc to be removed, and a distracting device is then attached to the pins. Any disc material pressing on the spinal nerves is removed. The artificial disc device is then placed with the assistance of xray image guidance. The muscle and skin incisions are sewn together with sutures. Steri-Strips and biologic glue is placed across the incision. Usually a drain is placed for postoperative bleeding.

The operation typically takes about one hour to perform plus additional time for anesthesia and placement of neuromonitoring systems. Most of these procedures require you to be kept in the hospital overnight to monitor the drain. The drain is typically removed the following morning. If you do not require a drain, you may be allowed to go home the day of the operation.

After Surgery

Usually, an Anterior Cervical Discectomy and Fusion procedure is performed on an outpatient basis, or with one overnight stay in the hospital. Those patients who require a wound drain will stay overnight. Generally, you will be encouraged to walk the day of surgery. After surgery, minor discomfort from your incision is common but temporary. This can be relieved with mild pain medication. Following the procedure, you may experience persistent numbness, weakness and pain along the path of the nerve that was decompressed, but these symptoms are generally temporary and gradually go away.

Patients are instructed to avoid bending and twisting of the neck and heavy lifting during the first several weeks. Patients can gradually begin to bend and twist their neck as the pain subsides and the neck and back muscles get stronger. Patients may begin driving when the pain has decreased to a mild level and mobility of the neck has improved, which varies between patients. Patients need to be able to turn their neck and body enough to see right and left while driving. You may not drive or operate machinery while on narcotic pain medication. Patients may return to sedentary work duties as early as 2-6 weeks after surgery, depending on your surgeon’s recommendation.

The wound area can be left open to air. No bandages are required other than to protect clothing from any remaining wound drainage. Drainage typically stops within the first day or so after surgery. Steri-Strips affixing the suture should be left in place. The area should be kept clean and dry. Showering may begin the day after surgery. Tub bathing, saunas and other environments that place the incision in a moist or wet environment for any length of time should be avoided until the incision heals.

Physical therapy is typically started 2 weeks after surgery. Restrictions are gradually lifted over the 6-12 weeks following surgery. Maximum medical improvement usually occurs 3-4 months after surgery, although you will usually need additional visits past that time frame to obtain Xrays to assess the implants.

Outcome Studies

The success rates for Cervical Disc Replacement are generally good and the recovery is typically a little quicker than for fusion. The surgery serves to improve pain and function and prevent further neurologic deterioration. Most patients are noted to have gradual improvement of their pain and function following surgery. Most patients will not notice any loss of neck range of motion.