Cervical Disc Replacement (CDR)
Overview:Cervical Disc Replacement (CDR) is a surgery to remove a herniated or degenerative disc in the neck. An incision is made in the throat area to reach and remove the disc. A disc replacement prosthesis is inserted to retain physiological intervertebral motion unlike fusion surgery. CDR surgery may be an option if physical therapy or medications fail to relieve your neck or arm pain caused by pinched nerves.
In ACDF- fusion is preformed between bones to prevent motion between them. This has disadvantages to decreasing neck motion and fear of pathology developing at adjacent levels due to altered biomechanical stresses. To circumvent these, a prosthesis know as Disc Replacement Prosthesis is inserted instead of the spacer filled with bone graft. Rest of the technique similar to ACDF surgery. However, the indications of disc replacement is limited. It is contra indicated in old patients, inflammatory pathologies, infections osteoporosis, instability, tumours to name a few.
Surgery is usually suggested as the last resort. Failure of medical management and severe neurological compression causing weakness are usual circumstances when surgery is advised. After a thorough discussion (understanding risks and benefits) with the surgeon, the decision for surgery is taken.
The procedure is done under general anaesthesia. A tube is inserted in the throat to help breathing during anaesthesia. The surgery is performed through a 1.5-2 inch incision taken in the front of the neck. Through the inter muscular planes, trachea (wind pipe), oesophagus (food pipe), important neuro vascular structures are retracted to access to the spine. After confirmation of level to be operated with C-arm (Intra operative X-ray), disc space is exposed. Adequate magnification is achieved with microscope/ surgical loupes. Disc annulus is cut and disc is removed with grasping tools. The spinal canal is exposed and any material causing compression of spinal cord/ nerves is removed. The vacant disc space is filled with artificial disc prosthesis which is bio inert and compatible. Everything is confirmed under C-arm and wound is stitched up. Sometimes, drain may be kept for 1-2 days to prevent haematoma formation. Patient is made to walk on same day/ next day.
After the surgery, patient may be shifted to ICU for observation or to the room depending upon the medical condition. Hoarseness, sore throat, or difficulty swallowing may occur in some patients and should not be cause for alarm. These symptoms usually resolve in 1 to 4 weeks.
Normally, 3-5 days of hospital stay is required. Once medical condition is stabilized, patient has adequate pain relief, with normal swallowing and speaking, patient is discharged once mobilized.
Patient is asked to follow up for stich removal between 2-3 weeks from surgery. A waterproof dressing may be applied so that bath can be taken. Patient is required to follow up at 6 weeks, 3 months, 6 months, 1 years and then annually after surgery for examination. Based on serial x-rays and recovery – gradual increase in activities is advised.
Disclaimer: The description of procedure is how usually a surgery is done. During the procedure, based on intra operative encounters which varies from patient to patient different steps may be performed.
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