Cervical Artificial Disk Replacement

What is cervical disk replacement (CDR) surgery?

Cervical disk replacement (CDR) surgery involves replacing a damaged spinal disk in your neck (cervical spine) with an artificial (prosthetic) disk.

Spinal disks are rubbery cushions between your vertebrae (bones in your spinal column). They act as shock absorbers and help you move, bend and twist comfortably. The goal of CDR surgery is to restore the height of a worn down (degenerated), collapsed disk space. This maintains the range of motion in your neck and may decompress nerve roots, which may help relieve pain.

There are several types of artificial cervical disks. The three main material types for them are cobalt, titanium and stainless steel.

You may have a lot of questions and concerns about needing neck surgery. While CDR is a newer type of surgery compared to other cervical spine procedures, several studies have shown that it’s effective and safe. Your surgeon will walk you through the process of CDR surgery and what you can expect.

Why might I need cervical disk replacement surgery?

Cervical disk replacement surgery is mainly for people who have cervical degenerative disk disease with pinched nerves (radiculopathy) or myelopathy. Your provider may recommend CDR surgery if conservative (nonsurgical) treatment hasn’t worked to manage your symptoms for at least six weeks.

Certain factors may disqualify you from being a good candidate for this surgery, like having:

• An active infection.
• Certain metal allergies (hypersensitivities).
• Osteoporosis.
• An unstable cervical spine.
• Severe facet arthropathy (arthritis that affects the facet joints in your spine).
• Severe neuromuscular conditions.

Together, you and your healthcare provider will decide if cervical disk replacement surgery is right for you. Providers most often compare CDR surgery to anterior cervical discectomy and fusion (ACDF) because they can treat many of the same issues. Your provider may compare and contrast CDR and ACDF when discussing your options.

How should I prepare for cervical disk replacement surgery?

You'll meet with your surgeon (either an orthopaedic surgeon or neurosurgeon) before your cervical disk replacement surgery. You can expect your surgeon to:

• Do a physical exam.
• Ask about your medical history and symptoms.
• Request imaging tests of your neck, like an X-ray, myelogram or MRI.
• Ask about the medications or supplements you take.
• Make changes to your medications, like removing or adding certain medications. Don’t stop taking medications unless your surgeon tells you to.

Let your healthcare provider know if you use tobacco products. Nicotine in tobacco products can interfere with your healing. Your provider may ask you to quit using these products at least four weeks before your surgery.

Your surgeon will also explain any risks or side effects and give you information about how you can prepare. If you have any questions or concerns, make sure to ask your surgeon before the date of your surgery.

What happens during cervical disk replacement surgery?

Your surgeon will go over the steps of CDR before the surgery. In general, the steps include:

1. An anesthesiologist will give you general anesthesia to put you completely to sleep so you won’t feel any pain.
2. Once you’re asleep, your surgeon will make an incision (cut) in the front of your neck. The exact location and length of your incision will vary based on your unique circumstances. They’ll move your trachea and esophagus to the side to access your spine.
3. Your surgeon will use imaging guidance called fluoroscopy throughout the surgery to see your neck vertebrae better.
4. Your surgeon will remove the damaged disk and replace it with an artificial disk.
5. Your surgeon will close up the incision site after moving everything back into place.

What happens after cervical disk replacement surgery?

After CDR surgery, your care team will move you to a recovery room where they’ll monitor your vital signs as you wake up from anesthesia. You may need to stay overnight in the hospital. Your healthcare provider will let you know when it’s safe for you to go home. You’ll need someone else to drive you home after surgery.

Your surgeon will give you instructions to help your body heal. This may include:

• Taking medications to alleviate pain.
• Resting and limiting physical activity (like avoiding aerobic exercises and lifting heavy objects).
• Caring for your incision site.
• Participating in physical therapy.

What are the benefits of cervical disk replacement surgery?

Several studies show that cervical disk replacement surgery provides significant short-term and long-term pain relief for many people. It can also help maintain the range of motion in your neck.

How successful is cervical disk replacement?

The majority of people who have cervical disk replacement surgery get symptomatic relief and can resume full activity after six months. But as with any treatment, it’s not guaranteed to relieve your symptoms.

What are the risks or complications of cervical disk replacement?

Short-term complications of cervical disk replacement surgery are rare but can include:

• Wound infection.
• Difficulty swallowing (dysphagia).
• Voice hoarseness.
• Sore throat that comes and goes.

Possible long-term complications of CDR include:

• Adjacent segment degeneration (ASD). This is degeneration that happens in the spinal segments next to (adjacent to) the replaced disk.
• Artificial disk-related failures.
• Heterotopic ossification (HO). This happens when bone grows in tissues where it typically wouldn’t.
• Possibly needing another, future surgery.

Your healthcare provider will go over all the possible risks and complications of CDR before your surgery.

How long does it take to recover from cervical disk replacement surgery?

It may take up to six months to fully recover from CDR surgery. Your surgeon will give you a timeline of certain activities you can build up to over time after surgery. In general, most people can:

• Return to activities of daily living (like grooming and preparing meals) by the second day after surgery.
• Return to regular, light activities between two to three weeks after surgery.
• Return to full activities (excluding contact sports) by four to six weeks after surgery.

Be sure to ask your surgeon for a complete list of activity restrictions.

When should I call my healthcare provider?

Contact your healthcare provider if you experience the following after cervical disk replacement surgery:

• Continuous bleeding from the incision site.
• Yellow or green (purulent) drainage from the incision.
• Severe pain.
• Fever.
• Worsening or persistent difficulty swallowing or eating.
• New weakness or numbness.

You’ll need to have follow-up appointments with your provider after surgery to make sure you’re healing well and that the artificial disk is functioning as it should. Your provider will let you know how many appointments this will be and when to schedule them.