Cervical Total Disc Replacement

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Surgery for the cervical spine is somewhat different from the lumbar spine. The presence of the spinal cord in the cervical spine limits what a surgeon can do from the back of the neck. Central herniated discs in the cervical spine cannot be treated from the back of the neck like in the lumbar spine because the cervical spinal cord cannot be retracted like nerves in the lumbar spine.

Central herniated discs require removal of the disc from the front of the neck. After removal of the disc and bone spurs impinging on the spinal cord and nerves, the empty disc space needs to be replaced by something to convey the weight of the head from the vertebrae above to the next vertebrae. In most cases this is done through a bone graft between the vertebrae in the empty disc space leading to a fusion. A plate is usually used to hold the vertebrae above and below the fusion immobile to enable the fusion. 

Because of the success of hip and knee joint replacement, total disc replacement has been touted as the holy grail of cervical disc surgery. Instead of fusing the disc space, an artificial disc capable of joint motion is placed into the empty disc space. It is thought that the mobility of the artificial joint relieves the extra strain that is placed upon neighboring (adjacent) levels after a fusion. Thus, theoretically, the adjacent level degeneration seen with cervical fusions may be reduced with total disc replacement/ cervical arthoplasty. Recent studies have shown that artificial disc replacement surgery is associated with better outcomes than fusions in terms of further surgery down the road. Additionally,  insurance companies are finally starting to recognize artificial disc replacement as a standard therapy for cervical radiculopathy. erimental.