Cervical disc replacement- a step ahead

Dr. R. S. Chahal, Dr. Shankar Acharya, Dr. K. L. Kalra

Although ACDF (Anterior Cervical Discectomy and fusion) is now an accepted gold standard for treating cervical spondylotic myeloradiculopathy due to cervical disc prolapse, however Spinal fusion has well known potential disadvantages, including:

• Loss of motion and flexibility
• Permanently altered motion characteristics and biomechanics
• Potential for accelerated degeneration of the discs above and below the fused level that can lead to more pain and the need for more surgery

Hypothesis that reconstruction of this degenerated disc with a functional prosthesis rather fusion can alleviate this problem is gaining ground.

Indication For Cervical Disc replacement

• Degenerative Disc Disease or Disc Herniation at C3, C4, C5, C6, or C7
• Radicular symptoms in the arms corresponding with affected disc (tingling, numbness, shooting pain)
• Neck Pain
• Failed conservative therapy

Contraindication For Cervical Disc replacement

• Infection
• Segmental instability / facetal arthropathy
• Osteopenia or osteoporosis
• Remaining general skeletal growth (paediatric)
• Severe osteomalacia, or metabolic bone disease
• Tumors or congenital abnormalities
• Fracture
• Case Report

When 40 year Old Kiran present to us in Spine OPD with severe arm pain she was evaluated with X-ray and MRI which showed C6-7 disc prolapse, She was put on conservative treated in form of analgesic and physiotherapy with which she had mild relief but radicular pain was quite disabling, She was offered surgery for which she consented, we reviewed the case and decided to do a artificial disc replacement in her based on the facts that:

1. Young age
2. Single level disc
3. No facetal arthropathy

MRI showing C5-6 disc

CT Scan showing reduced C5-6 Disc space and normal facetal alignment at C5-6

Procedure

Anterior approach- complete disectomy

End plate preparation

Measuring the disc size

Disc prosthesis in place

 

Post Op X-rays

 

Post Op: Day 1 clinical pictures