Cervical disk replacement surgery is to remove the offending disk while maintaining effective range of motion & which will eventually help prevent risk of adjacent level disease that usually develops following ACDF. Cervical disks are basically cushions or shock absorbers located between vertebrae of the cervical spine in the region of the neck. Natural cervical inter-vertebral disk is an amazing mechanical structure from a perspective examining its engineering capacity. Cervical disks hold an ability to absorb large compressive loads while providing impressive range of motion between bones within the neck region. Duplicating these functions of a natural cervical disk with artificial synthetic disks is extremely challenging. Several types of artificial cervical disks have however been developed are available as surgical options for patients suffering from symptomatic cervical disk problems.
Artificial cervical disk is a device which can be inserted between two vertebrae in neck region so as to replace a damaged disk. Intent of this replacement is to preserve function including motion at the disk site. This procedure is an alternative to anterior cervical discectomy & fusion (ACDF) which is a surgical intervention designed to address pathology by eliminating motion at diseased disk level site. Artificial Disk Replacement Surgery (ADR) is also known as Total Disk Replacement (TDR) or Total Disk Arthroplasty which is typically performed for patients with cervical disk herniation or cervical degenerative disk disease causing severe neck pain and/or arm pain which is unresponsive to nonsurgical treatment options affecting functional ability & quality of life of patients.
Although most symptoms from cervical disk herniation & cervical degenerative disk disease resolve on their own, some cases are found to be resistant to nonsurgical treatments & therefore require surgical intervention. While most surgical strategies require anterior approach to cervical spine, ACDF surgery replaces the defective disk with a block of bone leading to fusion of two vertebrae in place of disk. There are two joints of cervical spine called uncovertebral joints in front & two paired facet joints in back. This combination allows a wide range of motion & sufficient stability in neck region.
Having low-grade pain of an inflexible or stiff neck is the most common symptom. Many patients suffering from cervical disk degeneration also experience tingling, numbness or weakness in neck, shoulders or arms resulting of nerves within cervical area becoming pinched or irritated. Pinched nerve root within C6-C7 segment can easily result in weakness of forearms & triceps along with wrist drop & altered sensations in fingertips or middle fingers. Moreover, there is a possibility that cervical disk regeneration can contribute to development of cervical stenosis & various other progressive conditions including sudden disk herniation.
Cervical degenerative disk disease is generally fairly prevalent among people above age 40 with almost 60 percent of them showing radiographic evidence of cervical spine degeneration. Almost ninety five percent of men & seventy percent of women by age 65, show some sort of degenerative changes which can be seen on x-ray. Fortunately considered as a general aging phenomenon & not problematic, most of these people do not develop pain or other symptoms. However, disk degeneration in some cases can result in herniation of disk & bone spur formation (osteophyte).
Successful diagnosis of cervical degenerative disk disease starts with Spine Surgeons reviewing medical history of symptoms & performing physical examination so as to measure neck flexibility & extension of patients. Patients may be asked to perform specific movements & asked to report any increase or decrease in neck pain. In case physical examination warrants further investigation, imaging tests like CT scan, MRI or X-ray are taken. These diagnostic reports are meant to confirm whether & where cervical disk degeneration has occurred. These tests can also additionally identify if other conditions like calcification or arthritis are causing these symptoms.
Normally used to treat symptomatic cervical disk disease which has failed to improve with nonsurgical treatments, cervical disk replacement is a convenient option to anterior cervical discectomy & fusion, excluding situations where Arthroplasty is not suitable. Generally, cervical disk replacement is only approved for use at one cervical level & not for adjacent sites to previous cervical fusion. Cervical disk replacement procedure should not also be performed in children, or when there is instability at affected level including abnormal motion. Spondylosis or advanced degenerative changes affecting facet joints in back of spine at affected level also preclude use of cervical disk replacement device. However, artificial cervical disk replacement device should not be applied when significant osteoporosis or active infection is present on site. It should be noted that cervical disk replacement is a new & technically challenging surgical intervention whose exact indications still continue to evolve.
It is very important to understand that cervical disk replacement is not a motion-creation procedure but a motion-preservation technique. There are several factors involved while considering cervical disk replacement to traditional anterior cervical discectomy & fusion surgery. As a result of individual symptoms or amount of disk degeneration each patient must either be suitable for ACDF or cervical disk replacement as discectomy does not increase range of motion. Moreover, artificial disk insertion following discectomy is not likely to move an ankylosed or severely spondylotic disk which did not move prior to replacement. However, these options are best discussed between individual patient & the operating spine surgeon.
Standard cervical disk replacement surgical procedure requires an anterior approach to cervical spine quite similar to the ACDF operation.
Cervical Artificial Disk Replacement surgery will typically include the following –
Cervical disk replacement patients are typically discharged from the hospital either on the same day or next morning following surgery. Immobilization within a cervical collar may be required for 7 days depending upon the discretion of the surgeon. Resulting pain from this procedure is usually limited & markedly improves within 2 – 3 days. Nerve symptoms including numbness, pain & weakness are almost often dramatically improved within few hours following surgery, but may in some cases take weeks or months to recover. X-rays are taken after surgery in order to confirm proper positioning & effective functioning of artificial disk replacement device. Majority of patients are reported to be capable of returning to light work within 1 – 2 weeks of surgery & to normal level of activity within 6 weeks of time following cervical disk replacement surgery.
Tariff difference is very vast which goes from 70 – 80% less as compared to treatments performed in USA and other developed countries. If a patient opts to get low-cost cervical disc replacement surgery in India, they will have huge amount of cost savings. Cervical Disc Replacement Surgery starts from around $5,000 so as to give a fair idea of price difference which is evident in India.This cost estimate includes stay in a private room for particular count of days where a companion or family member can also stay with the patient, fees of doctor, medicines, nursing care, consumables and food for the patient. However, price may vary depending upon medical condition of patient and the surgeon as well.
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