Fusing a disc inevitably
transfers work to the
adjacent discs. So, unless there is a good reason to fuse the spine, the usual
course is a disc replacement as this offers to restore and or preserve movement
at the affected level.
Disc
replacement is therefore now more common than fusion after disc removal though
the evidence that it is actually better is not as tight as you might think.
Both operations are good. Your big decision is whether to have surgery or not.
If you have spent more time thinking about replacement vs fusion your mind has
been focused on the wrong issue - though this is an important decision too. Fusion is
needed if there is significant instability at the operated level –
spondylolisthesis or if there is a fracture as well as a prolapse.
Fusion is
also used if the disc space is already very narrow when the movement has
already been lost. If the facet joints are also worn and painful then disc
replacement can make this worse. Finally, if there are a lot of osteophytes
then these have to be drilled away. As a result of this bone work, the two
vertebrae can fuse around the replacement – this happens more often with some
discs than others and may occur as many as one in ten times.
Disc
replacement is not a guarantee of no more trouble nor does it prevent all
disease in the adjacent levels. You wore out the first disc without having had
a fusion so you may also wear out another. That said, our philosophy is to
preserve and restore function where possible.
Is there
good evidence to prove disc replacement is better? Not in the form of randomised
trials. Such trials are difficult to do, they have been flawed and to some
degree inconclusive. In our view, this reflects the difficulty of doing this
kind of study. For most patients, a logical choice can be made and where there
is doubt we would opt for disc replacement – you can fuse after if it does not
work but you cannot reverse a fusion.
Cervical Disc Replacement
Cervical
disc is a piece of specialized tissue that separates the vertebral bones of the
spinal column in the neck. Cervical disc disease is caused by an abnormality in
one or more discs. When a disc is damaged due to arthritis or an unknown cause
it can lead to neck pain from inflammation or muscle spasm. Severe pain and
numbness can occur in the arms from pressure on the cervical nerve roots. The
disc space is jacked up to its prior normal disc height to help decompress
(relieve pressure) on the nerves. In severe cases, when the patient is not
benefited from non-surgical treatments like medication or physiotherapy then
they are advised Cervical Disc Replacement Surgery.
The
Center of the disc, which is called the nucleus, is soft, springy and receives
the shock of standing, walking, running, etc. The outer ring of the disc, which
is called the annulus (Latin for ring), provides structure and strength to the
disc. Patients with cervical disc herniations are advised cervical disc
replacement, if they have not responded to non-surgical treatments like
medication or physiotherapy.In the surgery, an artificial disc replaces the
worn out or affected one and the disc space is jacked up to the normal height.
Once you
have had your offending disc removed, a simple fusion procedure can be
performed as the cervical spine reconstruction.
This is usually performed with a plate and integrated cage (PCB). This is filled with
recycled bone collected during the decompresion of the spine in addition to some
synthetic bone supplement. Usually no additional bone needs to be taken from
the pelvis. Profesional athletes involved in heavy contact sport such as rugby
may wish to utilise their own pelvic bone as it is still probaly provides for
the fastest and most secure fusion. Return to play is often possible at three
months.
the
device, filled here with synthetic bone, is ready for insertion. This technique
obliviates the need for a separate incision and the harvesting of the patient’s
bone from elsewhere, e.g. the pelvis.
After Surgery
Patients
are usually able to get out of bed within an hour or two after surgery. Your
surgeon may have you wear a hard or soft neck collar. If not, you will be
instructed to move your neck only carefully and comfortably. Most patients
leave the hospital the day after surgery and are safe to drive within a week or
two. People generally get back to light work by four weeks and can do heavier
work and sports within two to three months.
Outpatient
physical therapy is usually prescribed only for patients who have extra pain or
show significant muscle weakness and deconditioning.
Rehabilitation
Patients usually don't
require formal rehabilitation after routine cervical discectomy surgery.
Surgeons may prescribe a short period of physical therapy when patients have
lost muscle tone in the shoulder or arm, when they have problems controlling
pain, or when they need guidance about returning to heavier types of work. If
you require outpatient physical therapy, you will probably only need to attend
therapy sessions for two to four weeks. You should expect full recovery to take
up to three months.
At first,
therapy treatments are used to help control pain and inflammation. Ice and
electrical stimulation treatments are commonly used to help with these goals.
Your therapist may also use massage and other hands-on treatments to ease
muscle spasm and pain.
Active
treatments are added slowly. These include exercises for improving heart and lung
function. Walking, stationary cycling, and arm cycling are ideal cardiovascular
exercises. Therapists also teach specific exercises to help tone and control
the muscles that stabilize the neck and upper back.
Your therapist works with you on how to move and do activities. This
form of treatment, called body
mechanics, is used to help you develop
new movement habits. This training helps you keep your neck in safe positions
as you go about your work and daily activities. You'll learn how to keep your
neck safe while you lift and carry items and as you begin to do other heavier
activities
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