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The Cervical Artificial Disc
Just as there have been artificial disc replacements made for the lumbar spine, there are ones for the cervical spine. The cervical spine is significantly different from the lumbar spine in that it requires a great deal of motion but generally carries very little load. This mean that maintaining motion in the cervical spine is very important but also that discogenic pain from disc loading is not as common. More commonly, the cervical disc degenerate and lead to nerve compression. This nerve compression leads to shoulder and arm pain. True cervical pain from the discs is not as common but is definitely seen. The question is whether a artificial disc is warranted in this situations, especially when endoscopic cervical discectomy has a success rate of around 90% for such problems. The device is somewhat similar to the lumbar artificial discs and consists of metal plates with a silicon disc . Bending and flexion is maintained, but rotation is decreased which is very important in the cervical spine.
There are no good studies of this device and only one center is performing the insertion of the device on an experimental basis. The surgery is done through a standard conventional anterior cervical approach with a 2 to 3 inch incision.
The device is held in place by two screws. There are no long term studies about whether the device will loosen and possibly move. Although movement will be anteriorly and thus there isn't any risk of spinal cord impingement, there is a risk of esophageal or tracheal compression. This could possibly lead to problems with swallowing or even possibly breathing which may necessitate removal of the device and then fusion of the spine.
Thus, our concern is that there may be no real need for a cervical artificial disc when the long term success rates with endoscopic cervical discectomy or decompressive surgeries are so good. Nonetheless, This disc replacement system may be a very good resort when endoscopic discectomy fails.
Pictures of the surgical
implantation of the artificial
disc and the disc itself.