Cervical Disc Replacement
Cervical disc replacement, also known as total disc arthroplasty or artificial disc replacement is a procedure where a damaged cervical disc is removed and replaced with a metal or plastic prosthetic between two vertebral levels. This technique has gained popularity in recent years as it is a safe and effective procedure at relieving cervical pain and/or compression on the spinal cord. Typically done through a cosmetically appealing incision in the front of the neck, this procedure preserves motion at the neck with less failure when compared to neck fusion procedures.
Cervical Decompressive Surgery
The surgical treatment for cervical myelopathy centers around decompressing the pressure placed on the spinal cord. This involves removing the pieces of bone or soft tissue, such as a herniated disc, that may be taking up space in the spinal canal. This creates more space for the spinal cord leading to less compression and better nerve signal conduction. The commonly performed procedures to treat cervical myelopathy are an Anterior Cervical Diskectomy and Fusion (ACDF), laminectomy, laminoplasty, and cervical disc replacement.
Determining what surgery to perform depends on a number of considerations including patient factors, type of pathology, and the location of the problem. Depending on the procedure, surgery is performed either from the front of the neck (anterior), the back (posterior), or both. For many years, ACDF has long been the gold standard in cervical spine surgery as it is safe, effective, simple to perform and easy to recover. This procedure involves disc removal to relieve spinal cord compression followed by spinal fusion, or merging of adjacent vertebrae, to help stabilize the spine.
Cervical myelopathy is a form of spinal cord compression that occurs in the neck (cervical) region of the spine. The cervical spine consists of 7 bony vertebrae with fibrous discs between the vertebrae to help cushion the spine during everyday activities. Behind the vertebrae and discs is the spinal cord that functions to carry nerve impulses from the brain to the upper and lower extremities.
Cervical myelopathy can produce a myriad of symptoms to include neck pain, weakness to the upper extremities, poor hand coordination, and balance issues. This is most commonly caused by gradual degenerative changes to the spine, but other causes include trauma and autoimmune diseases (i.e. rheumatoid arthritis) which can cause compression on the spinal cord and subsequent nervous dysfunction. Some milder symptoms of cervical myelopathy can be treated with non-operative measures such as physical therapy, injections, and over the counter anti-inflammatory medications. More severe cases, or cases that fail to improve with nonsurgical modalities, may warrant surgical intervention.
The Zimmer-Biomet Mobi-C Cervical Disc was designed as a cervical disc replacement prothesis for the treatment of multiple pathologies including cervical myelopathy. This technology was originally designed by a French surgeon and first implanted in France in 2004. The design of this component allows for restoration of vertebral motion and disc height.
The Mobi-C was the first cervical disc FDA approved for both one and two-level disc disease with some clinical data showing statistically superiority to fusion type procedures. In a surgery with the Mobi-C Cervical Disc, the unhealthy disc is removed, but instead of a bone spacer or plastic implant along with a plate and screws, a Mobi-C is implanted into the disc space. Where a fusion procedure is intended to eliminate motion at the affected levels, the goal of surgery with Mobi-C is to allow motion at those levels.