A common complaint among patients of Utah Neurological Clinic is pain coming from a herniated disc. Below is a summary of what causes herniated discs, a brief description of two common treatment methods, and specific pros and cons related to a cervical disc arthroplasty.
In order to understand herniated discs, it is important to understand basic spinal anatomy. The spinal column is like a layered tube. Inside the tube is the delicate spinal cord that contains nerves from the brain to the rest of the body. The outside of the tube is made up of bony vertebrae that ring the spinal cord and give support and structure. In between the vertebrae are strong rubbery discs, which play an important role in absorbing shock.
However, these discs can sometimes weaken and rupture from old age or inflammation. When this happens, the disc can bulge out from between two vertebrae and compress the spinal cord. This bulge, also known as a herniation, of the disc can result in the pinching of the nerve and pain. Most herniated discs are located in the lower back and neck. Pain and weakness from a herniated disc can manifest itself in the arms, legs, and back.
Non-Surgical Treatment Options
Management of a herniated disc can be accomplished through a variety of treatments, such as pain medication or steroid injections. In addition we recommend physical therapy to see if the patient can strengthen the muscles around the herniated disc and alleviate the pain. However, for some individuals with persistent pain the best approach for treating a herniated disc is surgery.
Surgical Treatment Options
Currently, there are two major methods used when surgically treating a herniated cervical disc. One method is an anterior cervical discectomy and fusion (ACDF). In this procedure, a surgeon removes the damaged part of the disc and instead of replacing the disc the surgeon uses a bone graft to “fuse” the two vertebrae together. For patients with degradation present in the surrounding vertebrae this is likely the best option. If a patient only needs to be fused at one or two levels the loss of motion is very limited. Anterior cervical discectomy and fusion currently represents the majority of surgical cases when a patient exhibits a herniated disc accompanied by pain.
The second, method is called a cervical disc arthroplasty (CDA) also known as a disc replacement. Here, a surgeon removes the damaged portion of the disc and replaces it with a metal and plastic implant that simulates a real disc. This allows for slightly more motion to be maintained by the patient. We generally find the best surgical candidates for this procedure don’t have any degradation to the surrounding vertebrae. The FDA recently approved a two level artificial disc replacement expanding the number of patients that would qualify for this procedure.
Both methods can treat a disc herniation and yield excellent outcomes, but recent research shows that cervical disc arthroplasty has a slight advantage. There are a few cons to CDA. While the data slightly favors CDA, the overall statistical significance shows a small benefit of CDA over an ACDF procedure (Arthroplasty Versus Fusion in Single-Level Cervical Degenerative Disc Disease: A Cochrane Review). Additionally, CDA is a newer procedure and some insurance companies are reluctant to pay for it until more longitudinal studies showing increased benefit are completed. This can translate to a higher out of pocket cost for the patient. Finally, since the CDA is manmade, there is a chance that it could wear out and need replacement or otherwise be rejected by the body.
For every surgical procedure, there are pros and cons, and a CDA is no different. If you have a herniated disc and are trying to decide the best treatment for you, come and talk to myself or anyone of the experienced doctors at Utah Neurologic clinic. We will lead you through the different treatments and find the best option for you.
Lynn M. Gaufin, MD
Neurosurgeon, Utah Neurological Clinic
This website contains general information about medical conditions and treatments. The information is not advice, and should not be treated as such.