Cervical Disc Replacement Surgery in Los Angeles

Artificial disc replacement, also called cervical disc arthroplasty or cervical disc replacement, is a surgical alternative to cervical spinal fusion for carefully selected patients.

The procedure removes a damaged disc from between two vertebrae in the neck and replaces it with an artificial disc. The implant supports the space between the vertebrae while allowing movement at the treated spinal level.

During surgery, the patient is placed under general anesthesia. The surgeon makes a small incision at the front or side of the neck and carefully moves the muscles, windpipe, esophagus, blood vessels, and other structures aside to access the cervical spine.

The damaged disc and any disc fragments or bone spurs pressing on the nerves or spinal cord are removed. The vertebral surfaces are then prepared, and the artificial disc is placed into the empty disc space. Imaging may be used to confirm the implant’s position before the incision is closed.

Unlike anterior cervical discectomy and fusion, cervical disc replacement does not intentionally join the adjacent vertebrae. Its purpose is to preserve motion while relieving pressure on neurological structures. However, the procedure cannot guarantee a full or completely normal range of motion.

Depending on the implant and the patient’s condition, cervical disc replacement may be performed at one or two adjacent levels between C3 and C7. Each artificial disc has specific FDA-approved indications and limitations that must be considered when selecting the implant.

Cervical disc replacement may be used to treat symptomatic disc damage in the neck, including:

• Cervical herniated discs
• Cervical degenerative disc disease
• Cervical radiculopathy
• Cervical myelopathy caused by disc-level compression
• Spinal nerve-root compression
• Spinal-cord compression
• Bone spurs associated with cervical disc degeneration
• Loss of cervical disc height
• Arm pain caused by a pinched nerve
• Numbness, tingling, or weakness in an arm or hand

A herniated or degenerative cervical disc can narrow the space available for nearby nerves or the spinal cord. This may cause neck pain, pain that travels into the shoulder or arm, numbness, tingling, weakness, reduced hand coordination, or difficulty with balance and walking.

Cervical disc replacement is generally intended for symptoms that can be connected to one or two specific damaged discs. Disc degeneration visible on an MRI does not, by itself, establish that surgery is necessary. The imaging findings should correspond with the patient’s symptoms, neurological examination, and other diagnostic results.

Cervical disc replacement has specific eligibility requirements. Not every patient with a herniated or degenerative cervical disc is a suitable candidate.

Potential candidates may have:

• Persistent neck or arm symptoms associated with a damaged cervical disc
• Cervical radiculopathy or myelopathy
• A herniated disc, bone spurs, or loss of disc height confirmed by imaging
• Symptoms that correspond with the affected spinal level
• Good movement at the proposed treatment level
• Little or no severe facet-joint arthritis
• Stable cervical alignment
• Adequate bone density and bone quality
• One or two treatable cervical levels
• Skeletally mature bones
• Overall health suitable for surgery and anesthesia

Candidates have typically attempted appropriate conservative treatment without sufficient improvement. Depending on the implant, this may include at least six weeks of medication, physical therapy, activity modification, injections, or other nonsurgical care. Surgery may be considered sooner when weakness, myelopathy, or other neurological symptoms are progressing despite treatment.

Bone quality is particularly important because the implant must remain securely positioned between the vertebrae. Osteoporosis, osteopenia, or other conditions that weaken the vertebral bone may increase the risk of implant movement, sinking, or failure. Some cervical artificial discs specifically list osteoporosis or osteopenia as contraindications.

Cervical disc replacement may not be appropriate for patients with:

• Osteoporosis, osteopenia, or inadequate bone quality
• Severe facet-joint degeneration
• Significant cervical instability
• Advanced spinal deformity
• Active infection
• Allergy or sensitivity to implant materials
• Vertebral weakness caused by fracture or previous trauma
• Severe bridging bone-spur formation
• Certain inflammatory diseases affecting the spine
• Disease extending beyond the levels approved for the selected implant

Spinal fusion or another decompression procedure may be more appropriate when substantial instability, deformity, arthritis, or poor bone quality is present.

Patients are monitored in a recovery area after surgery as the anesthesia wears off. Some cervical disc replacement procedures are performed on an outpatient basis, while other patients may remain in the hospital overnight or for one to two days.

Walking and basic movement are generally encouraged soon after surgery. Patients may experience temporary neck soreness, throat discomfort, hoarseness, or difficulty swallowing because the cervical spine is accessed from the front of the neck.

Postoperative instructions may include:

• Taking short, regular walks
• Keeping the incision clean and dry
• Taking pain medication as directed
• Temporarily avoiding heavy lifting
• Limiting strenuous exercise
• Avoiding high-impact or contact activities
• Wearing a cervical collar when prescribed
• Gradually increasing daily activity
• Attending clinical and imaging follow-up appointments
• Beginning physical therapy when recommended

Many patients can perform basic daily activities within the first several days. Light activities may resume within approximately two to three weeks, and fuller activities excluding contact sports may be possible after four to six weeks. Complete healing and recovery can continue for several months, so the timing should be individualized by the surgeon.

Return-to-work timing depends on the patient’s symptoms and occupation. Someone with a sedentary position may return sooner than a patient whose work requires lifting, repetitive neck movement, driving, climbing, or strenuous physical activity.

Physical therapy may begin several weeks after surgery. Rehabilitation may focus on posture, neck and shoulder mobility, strength, body mechanics, and a gradual return to work, exercise, and recreational activities.

Arm pain caused by direct nerve compression may improve relatively quickly. Numbness, tingling, weakness, or balance problems may take longer because nerves and the spinal cord recover gradually. Longstanding neurological symptoms may not resolve completely.

Cervical disc replacement is generally considered safe for appropriately selected patients, but all spinal procedures carry risks.

Potential complications include:

• Infection
• Bleeding
• Blood clots
• Reaction to anesthesia
• Nerve-root injury
• Spinal-cord injury
• Spinal-fluid leakage
• Persistent or recurrent pain
• New or worsening numbness or weakness
• Temporary or persistent difficulty swallowing
• Hoarseness or voice changes
• Injury to structures in the front of the neck
• Implant movement, loosening, wear, or breakage
• Implant settling into the vertebral bone
• Bone growth around the artificial disc
• Reduced or lost motion at the treated level
• Continued degeneration of nearby spinal levels
• The need for revision surgery or spinal fusion

Artificial bone formation around the implant, called heterotopic ossification, may gradually restrict movement. Implant-related failure and the need for future surgery are also possible long-term complications.

Indicators of a successful recovery may include:

• Reduced pain traveling into the shoulder or arm
• Reduced neck pain associated with the treated disc
• Improved strength in the arm or hand
• Reduced numbness or tingling
• Better hand coordination
• Improved ability to work, sleep, exercise, or perform daily activities
• Maintained movement at the treated spinal level
• Stable implant positioning on follow-up imaging
• No evidence of neurological deterioration

Cervical disc replacement tends to be more predictable for relieving symptoms caused by nerve or spinal-cord compression than for treating generalized neck pain without a clearly identified source. Success also depends on appropriate patient selection, implant positioning, bone quality, and compliance with postoperative restrictions.

Patients should promptly contact their surgical team for fever, worsening wound redness or drainage, uncontrolled pain, increasing weakness or numbness, persistent difficulty swallowing, voice changes, chest pain, or difficulty breathing.