01 Jun Who is a Candidate for Cervical Disc Replacement?
Cervical Disc Replacement or Cervical Disc Arthroplasty (CDA) involves removing the disc for surgical decompression and replacing it with an arthroplasty device or replacement disc. The surgical procedure takes no longer than a traditional Anterior Cervical Diskectomy and Fusion. However, CDA allows mobility and proposes to reduce the risk of adjacent segment disease.
In general, patients who present with the majority of their symptoms, such as neck pain, should undergo cervical fusion. Otherwise, we use the criteria below:
- Age: 18 – 80 years old.
- Single or Two-Level Surgery between C3 and C7.
- Radiculopathy or myelopathy secondary to spondylosis, stenosis, disc herniation or foraminal stenosis.
- Loss of disc height.
- At least six – to eight weeks of conservative care.
Contraindications for the procedure include usually include previous surgery, trauma, poor bone quality, and severe spinal cord compression. Other specific criteria include:
- Axial neck pain only without disc herniation or stenosis.
- Severe myelopathy causing weakness.
- Mid-sagittal stenosis < 8 mm.
- Prior cervical spine surgery at the indexed level, unless there is a failed fusion.
- More than two levels need surgery.
- Segmental instability on flexion and extension views with > 3.5 mm subluxation.
- Disc height less than 3 mm.
- Severe facet joint degeneration.
- Significant kyphotic deformity.
- History of spinal osteomyelitis.
- Morbid Obesity with BMI > 40.
The main reason to perform arthroplasty is not only to preserve motion, but to prevent adjacent segment disease after the surgical procedure. Key considerations in those patients that have a poor outcome after CDA include those patients that have disc collapse greater than 50%; these patients are over distracted after CDA and have persistent neck pain. Another consideration is when axial neck pain is the only symptom with facet arthropathy, leading to continued neck pain after CDA.
If you feel you are a candidate for cervical disc arthroplasty, please call the office for a consultation visit.