What is cervical disk replacement surgery?

Your cervical spine is made up of seven bones called cervical vertebrae. These are stacked on top of each other. They form a bony column at the center of the neck. The cervical disks are the cushions that lie between two cervical vertebrae. They act as shock absorbers and joints to allow your neck to move freely.

Your cervical spine also forms a protective tunnel for the upper part of your spinal cord to pass through. This part of your spinal cord contains the spinal nerves that supply your upper body (neck, arms, hands, and upper torso) with sensation and movement.

The space between your vertebrae becomes too narrow when cervical disks become damaged or worn. Part of your vertebrae or your cervical disk can press on your spinal cord or spinal nerves. This can cause you pain, numbness, or weakness. Disk surgery may be recommended when these symptoms do not respond to nonsurgical types of treatment.

Cervical disk replacement surgery is also called cervical arthroplasty. It involves removing a diseased cervical disk and replacing it with an artificial disk. Before this procedure was available, the affected disk was removed and the vertebrae above and below were fused together to prevent motion.

Disk replacement surgery may have the advantage of allowing more movement and creating less stress on your remaining cervical disks than traditional cervical disk removal and fusion surgery.

Why might I need cervical disk replacement surgery?

Loss of space between your cervical vertebrae from cervical disk degeneration, or wear and tear, is common after neck injury. But it is also part of normal aging. Cervical disks begin to collapse and bulge with age. This happens to most people by age 60. But healthcare providers don’t know why some people have more symptoms from cervical disk degeneration than others.

Symptoms may include:

• Neck pain

• Neck stiffness

• Headaches

• Pain that travels down into your shoulders, between your shoulder blades, or into your arms

• Weakness of your shoulders, arms, hands, or legs

• Loss of equilibrium when walking

• Numbness or "pins and needles" feeling in your arms and hands

• Hand clumsiness when doing fine motor tasks like buttoning a shirt

• Dropping objects

• Trouble urinating

What are the risks of cervical disk replacement surgery?

While any surgery carries some risk, disk replacement surgery is a relatively safe procedure. You will need to sign a consent form that explains the risks and benefits of the surgery before you have surgery.

Disk replacement is a newer type of spine surgery. So there is less information on possible long-term risks and outcomes. Not everyone is a good candidate for disk replacement. Fusion may be more appropriate. Discuss with your surgeon the risks and benefits of disk replacement surgery compared with more traditional types of cervical spine surgery.

Some potential risks of cervical spine surgery include:

• Reactions to the anesthesia

• Bleeding

• Infection

• Nerve injury

• Spinal cord injury

• Spinal fluid leak

• Voice change

• Damage to the nerves that stimulate the vocal cords (vagus nerves)

• Stroke

• Damage to the carotid artery

• Difficulty breathing

• Difficulty swallowing

• Injury to the esophagus

• Failure to relieve symptoms

• Broken, displaced, or loosened artificial disk

• Need for further surgery

• Failure of the artificial disk to work correctly

There may be other risks. This depends on your specific health condition. Talk about any concerns with your surgeon before the procedure.

How do I get ready for cervical disk replacement surgery?

Ask your healthcare provider to tell you what you should do before your surgery. Below is a list of some common steps that you may be asked to do:

• Tell your surgeon about any medicines you take at home. This includes herbal supplements and over-the-counter medicines. You may be asked to stop taking aspirin or other medicines that thin your blood and may increase bleeding.

• Tell your surgeon if you or someone in your family has any history of reaction to general anesthesia.

• If you smoke, you may be asked to stop smoking well before surgery. And not to smoke for a time after surgery.

• Follow any directions you are given for not eating or drinking before surgery.

• Ask your surgeon if you should take your regular medicines with a small sip of water on the day of the procedure.

• You will be asked to sign a document called an informed consent before surgery. This form gives the healthcare provider permission to do your surgery. Signing it means you understand the risks and benefits of the surgery. And what other treatment choices are available. The form also states that you have had all of your questions answered to your satisfaction. Read the form carefully and make certain all of your questions are answered before you sign it.

What happens during cervical disk replacement surgery?

Just before the procedure starts, you will have an intravenous line (IV) started so you can receive fluids and medicines to make you relaxed and sleepy. This procedure is usually done under general anesthesia (you are asleep). Medicines may be given through the IV to put you to sleep. A tube may be inserted in your throat to protect your airway and supplement your breathing. The actual procedure may last a few hours. This is what may happen once the procedure begins:

1. Monitors are placed to check your heart, blood pressure, and oxygen level.

2. The area of your neck where the incision will be made is cleaned with a special solution to kill germs on the skin.

3. A 1- to 2-inch incision (surgical cut) is made on the side or front of your neck.

4. The important structures of the neck are carefully moved to the side until the surgeon can see the bones of the vertebrae and the cervical disk.

5. The cervical disk that is being replaced is removed after confirming with an X-ray that it is the right level.

6. If needed, bone spurs or ligaments compressing the spinal cord or nerve root will be removed.

7. The artificial disk is secured into the empty disk space.

8. The incision is closed using absorbable sutures (stitches) under the skin. The skin is then carefully closed with sutures that reduce any scarring.

9. A small drain is sometimes left coming out of the wound. It usually will be removed the next day.

10. A small dressing is put over the incision. A rigid or soft neck collar may be put on your neck to restrict motion. And you will be taken to the recovery area.

Some steps might be slightly different from those outlined above. Talk with your healthcare provider about what might happen during your procedure.

What happens after cervical disk replacement surgery?

You will be observed until you recover from the anesthesia in the recovery area. Pain after disk replacement surgery is normal. You may be given pain medicine in the recovery area.

Most people will need to spend 1 or 2 days in the hospital. This is what may happen during your hospital stay:

• Intravenous fluids may be continued until you can drink fluids well by mouth.

• Once you are able to drink normally, you will be able to start eating your normal diet.

• You’ll continue to take pain medicines if you need it.

• Your nurses will check your dressing and help you get out of bed and go to the bathroom.

• You may be given a support collar to wear in the hospital.

• You will be encouraged to get out of bed and move around as soon as you are able to.

Recovery and rehabilitation at home may be a little different for each person. But in general, here’s what you might expect:

• You may need to continue wearing a soft or rigid neck support.

• You will be able to eat your normal diet.

• You may need to return to your surgeon to have sutures removed.

• You will gradually start returning to normal activities. You should ask your surgeon about any activity restrictions and when you can take a regular shower or bath.

• You may start physical therapy after a few weeks.

• You should be able to return to full activities by 4 to 6 weeks.

You should call your surgeon if you have any of these problems:

• Fever

• Headache

• Bleeding, redness, swelling, or discharge from your incision site

• Pain that does not respond to pain medicine

• Numbness or weakness

• Trouble swallowing

• Voice change or hoarseness

• Problems breathing

Your healthcare team may give you other instructions about what you should do after your procedure.

Next steps

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure