Cervical disc replacement
In the digital age, technological breakthroughs in medicine are easy to broadcast but often they end up being more gimmick than advance. However, I believe that the artificial disc for the neck (cervical spine) represents genuine progress when used appropriately. A variety of types have been tested over the past 20 years or so and we now have reliable evidence that the newer types are doing well in the medium term (5 – 8 years). These flexible devices take the place of surgical fusion when there is persistent pain from a pinched nerve in the neck. It now appears that they are genuinely reducing the rate of secondary surgery that may be needed years after a fusion. I have found that my patients do well after artificial cervical disc, though I am careful about who I perform the procedure because it is not suitable for everyone.
The best situation for a cervical disc replacement is a person less than about 50 years old with a disc rupture causing nerve pain in the arm. Disc ruptures affect younger people on the whole, and they have less degeneration in the joints of their neck which means that it is worthwhile them having a mobile prosthesis because the joints will work properly. In an older person the motion of the disc replacement is not an advantage because their arthritic joints will be painful, in which case traditional fusion is a better option. The process of selection of procedure is based on imaging. MRI will show the disc protrusion; CT will show the structure of the facet joints and if they may be suitable for disc replacement. Sometimes a bone scan may be needed as this is good at revealing degenerative changes in joints.