If you have cervical spine pain that does not respond to conservative treatments for six to eight weeks, it is time to consider spine surgery.
If you are considering cervical spine surgery, the two main options are cervical disc fusion and cervical artificial disc replacement. But which one is right for you? We explore both options in this article so you can make an informed choice.
In most cases, neck pain is caused by issues with muscles, tendons, or ligaments. Anything from sleeping in an unusual position to whiplash can temporarily strain or sprain the neck. Neck muscle pain usually goes away within a few days to one to two weeks.
Cervical spine pain, which is neck, shoulder, and/or arm pain caused by one or more problems in the cervical spine, is different. Cervical spine pain may be caused by degenerative disc disease or osteoarthritis in the cervical spine. If cervical spine pain lasts for six weeks or more despite medical treatment, surgery may be needed to ease the pain.
Cervical disc replacement and cervical spinal fusion have one very important thing in common: The spine surgeon accesses the problematic disc or discs and relieves any place that is pressing on the spinal cord, the nerve root, or the spinal nerve. Also, the spine surgeon will remove the problematic spinal disc. At this point, the two spine surgery procedures differ. In spinal fusion, artificial bone material, and other substances are placed in the disc space between the spinal bones. In cervical disc replacement, the spine surgeon inserts an artificial disc in the disc space.
Importantly, the goal of spinal fusion is for the space between the spinal bones (vertebrae) to fuse together, like a broken bone that heals solidly. As you can imagine, the fused spinal bones no longer move independently, which decreases the mobility and flexibility of the spine. In artificial disc replacement surgery, the artificial disc holds the spinal bones apart and supports the weight of the spine and body above it; however, the artificial cervical disc also moves a bit, much like a natural spinal disc. Thus, patients who opt for artificial cervical disc replacement retain mobility and flexibility in the neck.
Cervical disc replacement may be a good choice for patients who have unrelenting cervical spine pain for six to eight weeks, despite medical therapy. For cervical disc replacement candidates, the procedure can relieve pain, restore height between cervical spine bones, and restore mobility in the cervical spine and neck. Neck mobility is especially important for patients who enjoy an active lifestyle and want to engage in activities that require the ability to bend, flex, and twist the neck.
Cervical spinal fusion is a good for patients who have unrelenting cervical spine pain for six to eight weeks, despite medical therapy, and who are not candidates for cervical artificial disc replacement. You may not be a candidate for cervical artificial disc replacement if you have cancer, bone infection, facet joint degeneration, inflammatory spondyloarthropathy, or osteoporosis.
Both spine surgery procedures have very low complication rates. The most common poor outcome of either procedure is that the surgery does not relieve neck pain. Even that is uncommon—the patient satisfaction rates after both types of spine surgery are around 90%. Both surgeries come with small risk of infection, bleeding, trouble swallowing, and nerve damage. It is possible that the spinal fusion will not fuse successfully, which may require an additional surgery. That is not a problem with artificial disc replacement. Conversely, artificial discs may move or fail, but this is relatively rare.
One advantage of cervical disc replacement over spinal fusion is that recovery is faster after replacement. After fusion, the space between the spinal bones needs to heal completely. If you have ever broken a large bone, you probably had to wear a cast for many weeks until the bone healed. The same thing is true for fusion. This healing process can take up to 3 months with spinal fusion.
With cervical disc replacement, there is no bone fusion, and the device is in its natural position immediately after surgery. Recovery after spinal fusion is usually many months, but after replacement, recovery is usually a matter of weeks.
Only a trained spine surgeon can help you decide if cervical spinal fusion or disc replacement is right for you. In most cases, people who are candidates for cervical disc replacement opt for that procedure because it restores neck mobility in ways spinal fusion cannot. On the other hand, not every patient is a candidate for cervical disc replacement. Therefore, some patients may only be able to select cervical spine fusion for pain relief.
Even though artificial spinal discs have been approved by the FDA for nearly two decades, not all spine surgeons offer both cervical spinal fusion and artificial cervical disc replacement. Unfortunately, if you choose a spine surgeon who only offers one procedure, it will severely limit your options. Thus, you should choose a surgeon who is board-certified in either orthopedic surgery or neurosurgery and fellowship-trained in spine surgery. You should also select a spine surgeon who has deep experience performing both cervical spinal fusion and artificial cervical disc replacement.
Spine surgery is a major life decision. Making the right choice between cervical artificial disc replacement and cervical fusion surgery is also very important. Both procedures can relieve cervical spine pain, but only one procedure—artificial disc replacement—can restore spinal mobility. If you are considering spine surgery for cervical spine pain, speak with a qualified spine surgeon who has extensive experience in both procedures.
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