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Alternative to Cervical Spinal Fusion Surgery
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Everyday actions like blow drying your hair, backing out of the driveway, and using a computer are routine for many of us. But for those suffering from chronic neck pain, these seemingly simple tasks can be daunting, and at times impossible to perform. But now a breakthrough procedure is offering hope for some people.
Neck Pain
Neck pain can be caused by an acute injury or by chronic overuse of the neck. Pain can result from indirect trauma like whiplash from an auto accident, or by rotation and compression of the disc, like when the force of impact lands on the top of the head. Other people are prone to neck strain injuries as a result of abnormal posture or normal "wear and tear." Picture someone sitting at a computer keyboard, straining to see a monitor that is incorrectly adjusted. Whichever the cause, the chief symptom is pain. Additional symptoms may include neck stiffness that can radiate into the lower back, the inability to perform daily work or activities and occasional difficulty with chewing, swallowing, and breathing.
While the rest of the spine is well protected, the cervical spine is encased in a small number of muscles and ligaments, and therefore more vulnerable to injury. Also, the neck's normal function requires greater range of motion than the rest of the spine.
A Common Problem
Degenerative Disc Disease (DDD) of the cervical spine or neck is a painful condition that strikes more than half of Americans by age 50 and is a more serious cause of neck pain and instability by breaking down the disc that acts as a cushion. When the disc looses flexibility, the compression causes pain with the movement of the head. Many patients find relief with medication and/or physical therapy. However, instability may indicate a need for surgery.
Surgery always needs to be considered as a last resort, according to Terence Chen, M.D., Medical Director of Neurosurgery at John Muir Medical Center - Walnut Creek Campus. "We generally try this surgery only after someone has failed to get results from more conservative treatments like physical therapy, medications, and cortisone injections," he says. "Most cervical spine problems can actually be treated without surgery."
Until this year, the "gold standard" in surgical treatment has been to fuse the degenerating discs together. While cervical disc fusion surgery has relieved pain in many patients, there is a tradeoff of loss of motion and flexibility in the treated vertebral segment and can result in more pressure on adjacent segments causing breakdown over time.
New Implant
Now, select patients with DDD have an alternative to fusion. In July, the FDA approved the first artificial metal disc designed especially for the cervical spine called the Prestige® Cervical Disc.
"We are pleased to offer this exciting new disc replacement surgery as an option for pain relief and improved motion," says Abid Qureshi, M.D., Chair of the Department of Orthopedic Surgery at John Muir Medical Center - Walnut Creek Campus. The technique involves replacing the patient's own damaged or herniated spinal disc with an artificial metal disc. The artificial disc can potentially prevent and protect the adjacent discs above and below against degeneration.
The surgery is performed through a tiny, 4-centimeter incision in the front of the neck. Patients usually spend just one night in the hospital after this treatment and recovery is much faster than from traditional fusion surgery—a few weeks at most, as opposed to two to three months for fusion. Doctors are optimistic about the promise of this new procedure for the right patients, and even more enthusiastic about what lies ahead. "I think we're going to see many new changes over the next two to three years," says Dr. Qureshi. "Several more disc designs will be going for FDA approval in the near future. This is a fast-moving area of medical technology and we at John Muir Health are proud to be part of these pioneering surgical solutions that carry a huge benefit for our patients."
Selective Surgery
While the new disc replacement surgery is promising, surgeons say it isn't for everyone. "The ideal patient is someone who has isolated, single-level disease and who is still fairly young and has a fairly mobile cervical spine," says Dr. Chen. The treatment isn't recommended for people who have multiple levels of disease, or who have arthritis, osteoporosis, myopathy (muscle weakness) and other conditions that can cause neck instability. While the new disc replacement surgery has its benefits, long-term studies aren't yet available. But for those that are good surgical candidates, maintaining full motion and being able to perform simple tasks without pain, makes the procedure a worthwhile consideration.