Newer Surgical Options for Herniated Discs

July 19, 2016 Brigham and Women's Hospital

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In artificial disc replacement (ADR), the damaged disc is removed and replaced with an artificial one that moves and shifts like a real disc.

If you are experiencing numbness and pain in your arms and shoulder, it may be the sign of a herniated disc in your neck (the cervical region of the spine).

“A herniated disc occurs when the soft inner gel that cushions the spine’s vertebrae protrudes into the spinal canal, placing pressure on nearby nerves. This pressure can lead to pain, tingling, numbness or weakness in the shoulders and arms,” says Dr. John Chi, Director of Neurosurgical Spine Cancer and a spine surgeon in the Department of Neurosurgery at Brigham and Women’s Hospital.

A herniated cervical disc may be managed with medication, physical therapy, and pain management; however, in cases where patients experience a significant reduction in the quality of life, surgery may be needed.

In the past, patients requiring surgery for cervical disc herniation had one option – anterior cervical disc fusion (ACDF), in which the damaged disc is removed and repaired using a bone graft and spinal implants to help relieve pressure on the nerves and the spinal cord. The procedure requires the bones above and below the disc to be fused together. Though ACDF is effective at providing pain relief, patients may experience a reduction in their range of motion due to the fusion of discs in the neck.  Furthermore, there is a chance that discs adjacent to the fusion may later herniate, requiring a second surgery.

Today, spine surgeons like Dr. Chi can offer certain patients with cervical disc herniation another option – artificial disc replacement (ADR). During this procedure, the damaged disc is removed and replaced with an artificial one that moves and shifts like a real disc. This can preserve a patient’s range of motion, allowing them to return to their regular activities.

Recently, Dr. Chi performed ADR on a patient who had previously undergone ACDF. Though ACDF initially relieved the patient’s pain, one of the cervical discs located next to the fusion herniated. The patient started experiencing significant pain once again. This time, the patient opted to undergo ADR. Compared to his first surgery, Dr. Chi’s patient had a shorter hospital stay, a faster recovery, and maintained his full range of motion, in addition to gaining pain relief.  Artificial disc replacement is not for everyone. You may be a candidate for ADR if you are younger than 55 years and have been experiencing symptoms for at least three months but not longer than 18 months.

It’s not known how long artificial discs will last; however, they have been used worldwide for almost 20 years and for 12 years in the U.S.  In that time, there has been no evidence to suggest that they may require replacement after a certain period of time.  Research also indicates that ADRs may lead to better outcomes than fusion.  Dr. Chi advises checking with your insurer to verify your coverage if you are considering ADR.

Learn more about the Comprehensive Spine Center at Brigham and Women’s Hospital.

-Jamie R.

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