Cervical Disc Arthroplasty

What Is Cervical Disc Arthroplasty?

Cervical disc arthroplasty, also known as cervical total disc replacement (TDR), is a surgical procedure designed to treat symptomatic cervical disc disease while preserving motion at the treated vertebral level. During the procedure, a damaged or degenerated intervertebral disc in the neck is removed and replaced with an FDA-approved artificial disc implant.

Unlike cervical fusion, which immobilizes the treated segment to eliminate pain, disc arthroplasty maintains the ability of the neck to move naturally. The artificial disc is designed to mimic the biomechanical function of a healthy natural disc, absorbing forces across the cervical spine while allowing flexion, extension, and lateral bending.

The procedure is performed through a minimally invasive anterior (front) approach, which avoids damage to the neck muscles and provides direct access to the cervical intervertebral disc. This technique has been refined over decades and is supported by extensive clinical research demonstrating safety and effectiveness.

Who Is a Candidate for Cervical Disc Arthroplasty?

Not every patient with cervical disc disease is a candidate for disc arthroplasty. Careful patient selection is essential to optimize outcomes. Ideal candidates typically have:

• Single or two-level disc herniations or degenerative disc disease causing neck pain, arm pain (radiculopathy), or weakness
• Myelopathy symptoms (spinal cord compression) that have failed conservative treatment
• Failed conservative management for at least 4–6 weeks, including physical therapy, NSAIDs, and possibly cervical traction or injections
• No significant facet joint arthritis at the treatment level, as this may affect long-term outcomes
• Preserved disc height and no severe osteoporosis
• Reasonable spinal alignment without significant kyphosis or instability
• Age considerations: Most published data support disc arthroplasty in patients under 70, though careful evaluation is needed for each case

Conditions that typically preclude disc arthroplasty include severe facet arthropathy, significant instability, severe osteoporosis, or extensive cervical myelopathy requiring multilevel fusion. Dr. DelSole will thoroughly evaluate your imaging and clinical presentation to determine if you are an appropriate candidate during your initial consultation.

Benefits of Cervical Disc Arthroplasty Over Fusion

While cervical fusion remains an effective and well-established procedure, cervical disc arthroplasty offers several potential advantages:

• Motion Preservation: Unlike fusion, which eliminates motion at the treated level, disc arthroplasty preserves natural neck movement. This may reduce compensatory stress on adjacent segments.
• Reduced Adjacent Segment Degeneration: By maintaining motion and distributing forces more naturally, disc arthroplasty may theoretically lower the incidence of adjacent segment disease—a common long-term concern after fusion.
• No Bone Graft Required: Fusion typically requires bone graft material, whereas disc arthroplasty does not. This eliminates graft-site morbidity and potential complications.
• Faster Return to Activity: Many patients report a quicker functional recovery and return to normal activities compared to fusion.
• Improved Patient Satisfaction: Clinical studies show high patient satisfaction rates with modern artificial disc systems, particularly regarding pain relief and functional outcomes.
• Lower Reoperation Rates for Adjacent Segment Disease: Long-term data suggests lower rates of reoperation for adjacent level pathology compared to fusion, though continued long-term follow-up is ongoing.

What to Expect: Before, During, and After Surgery

Pre-operative Preparation

Before surgery, you will have a comprehensive pre-operative evaluation, including blood work, imaging review, and a consultation with anesthesia. Dr. DelSole will discuss the procedure in detail, review the specific technique for your case, and address any questions or concerns. You will receive detailed instructions regarding fasting, medications to discontinue, and arrangements for post-operative care.

The Surgical Procedure

Cervical disc arthroplasty is performed under general anesthesia through an anterior cervical approach. The procedure typically takes 1 to 2 hours for a single level, depending on complexity. Here's what happens:

• An incision is made in the front of the neck (hidden in a natural skin crease)
• Muscles and soft tissues are gently retracted to expose the spine
• The damaged intervertebral disc is carefully removed
• The disc space is prepared and implant sizing is confirmed
• The artificial disc implant is inserted and positioned
• The soft tissues are closed in layers and the incision is sutured

Hospital Stay

Most patients go home the same day or after an overnight observation stay. Disc arthroplasty is minimally invasive, which translates to less tissue trauma compared to fusion approaches.

Post-operative Recovery

Immediate post-operative period (Weeks 1–2): You will experience some neck soreness and stiffness, which is normal. Pain is typically managed with prescribed medications. You should keep your neck relatively immobilized with a soft cervical collar to protect the healing tissues. Most patients can return to light activities and desk work within 1–2 weeks.

Progressive recovery (Weeks 3–6): Gradual increase in activity tolerance. You may begin gentle range-of-motion exercises as tolerated. Physical therapy typically starts around 3 weeks post-op to restore strength, flexibility, and function.

Return to full activity (Weeks 6–12): By 6–8 weeks, most patients can resume normal daily activities, light exercise, and driving. Return to strenuous activities or heavy lifting is typically cleared around 8–12 weeks post-op, depending on how you're healing.

Most patients report significant pain relief within the first few weeks, with continued improvement over 3–6 months as inflammation resolves and neural structures decompress. Full tissue integration and stabilization of the implant takes several months.

Risks and Considerations

While cervical disc arthroplasty is a well-established and relatively safe procedure, all surgery carries some risk. Important considerations include:

• Heterotopic Ossification (HO): The formation of bone around the implant can occur in some patients, potentially limiting motion. Most cases are mild and asymptomatic, though preventive measures (such as brief anti-inflammatory medication) are sometimes used.
• Implant Subsidence: The disc implant may settle slightly into the vertebral bodies over time. While usually minimal and asymptomatic, significant subsidence could compromise outcomes.
• Device Wear or Failure: Like any mechanical device, artificial discs can theoretically wear over time. Long-term data beyond 10–15 years is still being gathered.
• Revision Surgery: If the artificial disc fails or symptoms persist, revision surgery may be necessary. Revision is more complex than primary surgery but is feasible.
• Infection: Surgical site infections are rare but possible with any operation.
• Nerve or Vascular Injury: While uncommon, these structures can be injured during surgery, potentially causing weakness, numbness, or other complications.
• Persistent Symptoms: Not all patients achieve complete symptom relief, though the majority experience substantial improvement.

Dr. DelSole will discuss these risks in detail with you during your consultation and will select the implant system and surgical technique that optimize safety for your specific anatomy and pathology.

Why Choose Dr. DelSole for Your Cervical Disc Arthroplasty

Dr. Edward M. DelSole is a fellowship-trained orthopaedic spine surgeon with extensive experience in cervical disc replacement and all anterior cervical procedures. Here's what sets his practice apart:

• Fellowship Training: Completed a prestigious spine fellowship at the Rothman Institute, one of the nation's leading spine centers, where he trained extensively in disc arthroplasty and complex cervical pathology.
• Board Certification: Certified by the American Board of Orthopaedic Surgery (ABOS) in orthopaedic surgery, demonstrating commitment to high standards of surgical care.
• Advanced Implant Expertise: Proficient with the latest FDA-approved cervical disc replacement systems and familiar with their unique biomechanical properties and insertion techniques.
• Medacta International Consultant: Serves as a consultant for Medacta International in evaluating 3D printed titanium technologies, staying at the forefront of implant innovation.
• Minimally Invasive Techniques: Emphasizes refined surgical technique to minimize soft tissue trauma and optimize recovery.
• Personalized Care: Each patient receives a comprehensive evaluation to determine the most appropriate treatment—whether disc arthroplasty or alternative approaches like ACDF or fusion.
• Long-term Follow-up: Committed to monitoring your outcomes and providing ongoing care and support throughout your recovery.