What is disc replacement ?

Disc replacement surgery a motion preserving surgery meant to achieve pain relief from a Slip Disc, degenerative disc disease or as a treatment of symptomatic Spondylosis This procedure is called an Artificial Cervical Disc Replacement, or ACDR when done in cervical spine for degenerative disc disease or Slip Disc . Its a better alternative to spinal fusion routinely advised in patents for same problem . Disc replacement when done in lumbar psine, though less indicated and done rarely these days is called lumbar TDR . An artificial disc replacement in the neck replaces a diseased or damaged disc with a specialised implant that tries to preserve motion in the neck. Its a modern technique to preserve motion in surgical patients which usually otherwise would require a spinal fusion . Spinal fusion has its long term disadvantages like ,loss of flexibility, adjacent segment stenosis, adjacent segment degeneration etc. Artifical disc replacement, also called Total Disc Replacement results in similar pain relief as does a spinal fusion, but also reduces the chances of developing long term side effects of spinal fusion .. In this procedure discectomy is done 1st in which disease disc was taken out than in place of diseased disc artificial disc was kept. This procedure is also commonly referred to as a Cervical Arthroplasty procedure as it replaces a joint.

Indication of disc replacement :

This procedure is done to treat the following condition:

1-Degenerative disc disease
2-Spinal Stenosis
3- Slip Disc / Herniated Disc causing Back pain / Neck Pain
4-Radiculopathy in cervical spine, this is not a indication in lumbar TDR

Artificial Cervical Disc Replacement cannot treat spinal instability.

Advantages of disc replacement over fusion :

1- A disc replacement is designed to preserve spinal motion and keep the cervical spine properly aligned.
2-  A disc replacement is thought to reduce mechanical stress on levels of the spine above and below the replacement when compared to a fusion.
3- Preservation of movement of neck as compare to fusion. A fusion surgery also keeps the cervical spine properly aligned, but any fusion decreases motion at that level. Because a disc replacement retains motion, the replacement experience stresses

Disadvantages of Disc Replacement :

At this point, research does not show the lifespan of an implant; this may need to be replaced in the future by a fusion procedure. How is the surgery performed-

This surgery is done under general anesthesia, meaning the patient goes to sleep. During the surgery the patient lies face up on a special surgical bed. The procedure is performed through a small incision on the front of the neck to gain access to the spine, usually in the neck’s natural crease. The trachea (windpipe), esophagus (stomach tube), and blood vessels lie in front of the spine and are carefully moved aside. Once the surgeon safely creates a window to see the spine, the damaged disc is removed with surgical tools. This part of the surgery is called a discectomy. The surfaces of the vertebral bodies are prepared to accept the implant. The bones are slightly spread apart to make more room for the disc replacement. This realigns proper curvature and enlarges the openings to relieve pressure off any pinched nerves. The artificial disc is inserted into the space between the vertebrae and carefully secured into place.

Complication of surgery :

Although they are rare but may be happen after surgery.they are as follow

1-Dysphagia due to pharyngeal or esophageal injury(0.3 %)
2-Dysphonia due to recurrent laryngeal nerve injury( 1%)
3-Injury to the treachea(<0.1 %)
4-Injury to major vessel-vessel into the carotid sheath( <0.1 %)
5-Horners syndrome -Injury to Sympathetic ganglion(0.1 %)
6-Dural perforation(0.5 %)
7-Wound infection(0.4%)
8-Worsening of myelopathy/radiculopathy(0.2%)

Although complication are very rare but can be manage successfully in almost every case.