16758 Cervical Artificial Disk Replacement

Overview

Cervical artificial disc replacement (also called cervical disc arthroplasty) is a type of neck surgery. Your spine is made of bones called vertebrae, stacked like blocks. Between them sit soft, cushion-like pads called discs. A disc in your neck can wear out or bulge and press on a nerve. In this operation, the surgeon removes the damaged disc and puts a small artificial (man-made) disc in its place. Unlike spinal fusion — where two bones are joined and stop moving — an artificial disc is designed to keep the neck moving, more like a natural joint.

It is much less common than spinal fusion. Only some people with neck problems are good candidates for it, and whether it is available varies between hospitals and countries.

It is usually considered for adults in their 30s to 50s who have neck or arm pain from a worn or slipped disc in the neck, and whose symptoms have not settled with non-surgical treatment. It is rarely done in children or in older adults with a lot of arthritis in the neck.

Symptoms

Common symptoms

• Neck pain that may spread to the shoulder or between the shoulder blades
• Pain, tingling, numbness or a 'pins and needles' feeling in the arm or hand
• Weakness in the arm, hand or fingers — for example, dropping things or finding buttons hard
• Headaches, often starting at the back of the head
• Stiffness or a grinding feeling when you turn your head

Symptoms in children

• Neck disc problems are rare in children. When a child has neck pain, doctors usually look for other causes first, such as injury, infection or muscle strain.
• See a doctor promptly if a child has neck pain with fever, a stiff neck, or weakness in the arms or legs.

Symptoms in older adults

• Older adults often have neck pain from general wear and tear (arthritis) in the neck joints as well as disc problems.
• Symptoms may include balance problems, a feeling of clumsiness in the hands, or weakness in the legs, which can be a sign of pressure on the spinal cord.
• Artificial disc replacement is less often suitable when there is a lot of arthritis, so doctors may suggest other options.

Causes

Main causes

• Wear and tear of a neck disc over time, sometimes called degenerative disc disease
• A disc that has slipped or bulged (a herniated disc) and is pressing on a nerve
• Injury to the neck, such as from a fall or a road traffic accident
• Narrowing of the space where nerves leave the spine, which can squeeze a nerve

Risk factors

• Getting older — discs naturally lose water and become less springy
• Smoking, which reduces blood flow to the spine and speeds up wear
• Repeated heavy lifting or awkward neck positions at work
• Long hours sitting with a bent neck, for example at a computer or looking at a phone
• Previous neck injury
• Family history of spine problems
• Being overweight, which adds load to the spine

When to see a doctor

See a doctor urgently if:

• Weakness in an arm or hand that is getting worse
• Numbness that is spreading or affecting both arms
• Neck pain after an accident, fall or sports injury
• Neck pain with fever, feeling generally unwell, or a stiff neck that will not ease
• Problems walking, balance problems, or clumsy hands

Book a routine appointment if:

• Neck pain lasting more than a few weeks, even if mild
• Pain that spreads into the arm, shoulder or hand
• Tingling or numbness in the arm that comes and goes
• Neck stiffness that limits your daily activities
• You are considering surgery and want to talk about your options

Diagnosis

Your doctor will start by asking about your pain: where it is, what makes it better or worse, and whether you have numbness or weakness. They will examine your neck, arms and reflexes, and may test your strength, feeling and hand coordination. If surgery is being considered, imaging scans help show which disc is causing the trouble and whether an artificial disc is a safe option for you.

Tests that may be done

• A physical examination of your neck, shoulders, arms, strength, feeling and reflexes
• X-rays of the neck, sometimes taken while you bend and straighten it
• An MRI scan, which shows the discs, nerves and spinal cord in detail
• A CT scan if more detail about the bone is needed
• Blood tests, if your doctor wants to rule out infection or other conditions

What to expect at your appointment

You may be asked to try non-surgical treatment first, such as physiotherapy and pain relief, before surgery is discussed. If surgery is an option, you will usually meet a spinal surgeon who will explain the benefits and risks, and check whether an artificial disc is suitable for you. This often includes reviewing your scans and may include a second opinion.

Treatment

Most neck disc problems are treated without surgery. Treatment focuses on easing pain, keeping your neck moving gently, and strengthening the muscles that support the neck and shoulders. Surgery is considered only when symptoms are severe or not improving, especially if there is weakness or pressure on a nerve or the spinal cord.

Self-care at home

• Keep gently active — staying still for long periods tends to make neck pain worse
• Take short breaks from screens and change position often
• Use a supportive chair and raise your screen so you are not looking down for hours
• Try a warm pack or cool pack on the neck for short periods
• Ask your pharmacist about simple pain relief that is safe for you
• Do the gentle neck and shoulder exercises your physiotherapist or doctor recommends
• Avoid heavy lifting or awkward twisting while symptoms are bad

Medical treatments

Doctors may suggest a combination of approaches: pain relief bought from a pharmacy or prescribed by your doctor, physiotherapy to improve movement and strength, and in some cases a specialist injection into the neck area to calm inflammation. Your doctor will talk through the options with you and choose what suits your situation, taking into account your other health conditions and any medicines you already take. Always check with your pharmacist or doctor before starting any medicine, including ones you buy without a prescription.

When is surgery considered?

Surgery may be discussed if pain or nerve symptoms are severe, if you have weakness in your arm that is getting worse, if scans show pressure on the spinal cord, or if symptoms have not improved after a good trial of non-surgical treatment (often around six to twelve weeks, depending on your case). Artificial disc replacement is usually offered only when a single disc is the problem and the neck has enough healthy movement. Your surgeon will explain whether fusion, disc replacement or another approach is better for you.

Living with this condition

Recovery after neck surgery varies from person to person. Many people stay in hospital for a short time and go home within a day or two. You may have some soreness in the neck and shoulder for a few weeks, and you may be asked to avoid heavy lifting, contact sports and long periods in awkward positions for a while. Most people gradually return to office work within a few weeks, and to heavier or more physical work later, depending on their surgeon's advice. Follow the instructions your surgical team gives you — they know your case.

Lifestyle tips

• Build up activity slowly and steadily rather than in big bursts
• Set up your desk and screen so your neck stays relaxed
• Quit smoking — it helps healing and long-term spine health
• Keep to a healthy weight to reduce strain on your spine
• Stay consistent with the neck and shoulder exercises you are given
• Pace yourself and rest before you get sore, not after

Diet and exercise

A balanced diet with enough protein, calcium and vitamin D supports healing and bone health. Gentle movement is helpful — walking is a good place to start. Once your surgical team says it is safe, a physiotherapy programme focusing on neck, shoulder and upper back strength will help you get the most from your recovery. Avoid contact sports, heavy weights and high-impact activities until you are advised otherwise.

Mental health and emotional wellbeing

Long-standing neck and arm pain can wear you down. It can affect sleep, work, mood and relationships, and it is completely normal to feel frustrated or anxious, especially around the time of surgery. Talking to your doctor, a physiotherapist or a counsellor can help. If you feel low, overwhelmed, or hopeless, please reach out to a trusted healthcare professional or a mental health crisis service in your area straight away — you do not have to cope alone.

Prevention

You cannot fully prevent the natural wear and tear of neck discs, but there is a lot you can do to look after your neck. Staying active, keeping to a healthy weight, quitting smoking, and setting up your work and screen so your neck is not bent for long periods all help. Good lifting technique — keeping the load close and using your legs rather than your neck — also protects your spine.

Screening programmes

There is no routine screening test for neck disc problems. If you have lasting neck or arm symptoms, see your doctor rather than waiting for a screening programme.

Complications

If left untreated

• Pain that carries on and affects sleep, work and mood
• Ongoing numbness or weakness in the arm or hand
• Pressure on the spinal cord, which can cause clumsy hands, balance problems and walking difficulty if it is not treated
• Rarely, permanent nerve damage if severe pressure is left for a long time

Long-term outlook

Most people with neck disc problems improve without surgery. For those who do have artificial disc replacement, many notice good relief of arm and neck pain, and the aim is to keep more natural neck movement than fusion. Every person is different, and results depend on your general health, the state of your neck and how well you follow your recovery plan. Your surgical team will be honest with you about what to expect — and whatever happens, support is available to help you keep your quality of life.

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