Artificial Disc Replacement (Single and Two Levels) of Cervical Spine

Why Is Artificial Disc Replacement Performed?

The main purpose of Artificial Disc Replacement surgery is to treat both neck pain and neurological problems resulting from cervical disc degeneration or herniation. Pressure on cervical spine discs causes nerve or spinal cord compression, leading to pain, numbness, tingling, and weakness that extend from your neck into your arms and hands. ADR becomes an option after non-invasive treatments fail to reduce symptoms.

The key difference between spinal fusion and ADR surgery is that ADR preserves natural cervical spine motion. Maintaining adequate spinal movement after surgery minimises the development of adjacent segment disease, which can damage motion-bearing segments above and below fused vertebrae over time.

ADR benefits people who want to stay active and need full neck motion. It improves quality of life by addressing underlying causes while preserving spinal functionality, leading to decreased pain and improved mobility during daily activities.

Single-Level vs. Two-Level Artificial Disc Replacement

Artificial Disc Replacement can be performed at one or two levels of the cervical spine, depending on the severity and extent of disc degeneration. The choice between single-level and two-level ADR depends on your condition, symptoms, and diagnostic findings. Understanding these differences helps determine the most appropriate treatment for restoring spinal function and relieving pain.

Key Differences

Single-level ADR involves replacing one damaged disc while preserving movement at that level. It is ideal if only one disc is affected and adjacent levels remain healthy.

Two-level ADR is recommended if two consecutive discs are damaged, causing nerve compression or spinal instability. This procedure restores mobility while preventing excessive stress on nearby vertebrae.

Recovery and rehabilitation are similar for both procedures, but two-level ADR may require slightly longer healing due to the involvement of multiple segments.

When Is a Two-Level Replacement Necessary?

• When two adjacent discs show significant degeneration, leading to severe pain or neurological symptoms.

• If nerve compression at multiple levels affects arm strength, sensation, or coordination.

• When conservative treatments fail to provide relief for multi-level cervical disc disease.

What Health Conditions Require Artificial Disc Replacement?

Artificial Disc Replacement effectively treats various cervical spine disorders that cause chronic pain, restricted movement, and nerve compression. If you experience persistent symptoms despite non-surgical interventions, ADR may provide long-term relief and functional restoration.

Degenerative Disc Disease

Degenerative Disc Disease (DDD) occurs when the cushioning discs between your cervical vertebrae break down due to aging or wear and tear. As the disc deteriorates, it loses hydration and height, leading to nerve compression and chronic neck pain. ADR replaces the damaged disc with a prosthetic one, alleviating symptoms while preserving motion.

Herniated Disc

A herniated disc occurs when the inner gel-like core of a spinal disc pushes through its outer layer, irritating nearby nerves. This condition can cause intense neck pain, radiating arm discomfort, and muscle weakness. ADR removes the affected disc and replaces it with an artificial one, relieving nerve pressure and restoring spinal stability.

Cervical Radiculopathy

Cervical radiculopathy results from nerve compression in the cervical spine, causing pain, numbness, and weakness that extend into the arms and hands. ADR effectively addresses this condition when conservative treatments fail by decompressing the affected nerves while maintaining cervical spine flexibility.

Cervical Myelopathy

Cervical myelopathy occurs when spinal cord compression leads to coordination difficulties, balance problems, and weakness in the limbs. If left untreated, it can cause permanent nerve damage. ADR helps by removing the problematic disc, relieving pressure on the spinal cord, and preventing further neurological decline.

Failed Previous Treatments

If you have undergone conservative treatments such as physical therapy, medications, or injections without success, ADR may be the next step. It provides a long-term solution when non-surgical approaches fail to control pain or restore function.

Indications for Artificial Disc Replacement Surgery of the Cervical Spine:

Artificial Disc Replacement is recommended when non-surgical treatments fail to relieve persistent cervical spine symptoms. If neck pain, nerve compression, or mobility limitations interfere with daily activities, ADR may be a practical solution. The decision to undergo ADR depends on several medical factors.

• Chronic Neck Pain: Persistent neck pain that does not respond to medications, physical therapy, or lifestyle modifications.

• Nerve Compression: Symptoms include numbness, tingling, or weakness in the arms or hands due to spinal nerve compression.

• Disc Degeneration: MRI-confirmed disc degeneration causing instability and reduced spinal function.

• Herniated Cervical Disc: A herniated disc presses on nerves or the spinal cord, causing pain and neurological deficits.

• Active Lifestyle Needs: If maintaining neck mobility is crucial for work or physical activities, ADR is preferable over spinal fusion.

• Failure of Conservative Treatments: When pain persists despite medications, physiotherapy, or spinal injections.

Key Aspects of the Surgical Procedure: Artificial Disc Replacement (Single and Two Levels) of the Cervical Spine

• Purpose of the Procedure: Artificial Disc Replacement (ADR) is a motion-preserving alternative to spinal fusion. It relieves nerve compression caused by degenerated or herniated discs while maintaining normal cervical spine mobility by replacing the damaged disc with a prosthetic one.

• Anaesthesia and Positioning: The procedure is performed under general anaesthesia. The patient is positioned supine (lying on the back), with the neck gently extended to expose the anterior cervical spine.

• Surgical Exposure: A small horizontal incision is made on the front of the neck, typically along a natural skin crease. Using a microsurgical approach, the soft tissues are gently retracted to expose the affected disc space without injuring nearby structures such as the trachea, esophagus, or carotid artery.

• Disc Removal and Decompression: The diseased disc is carefully removed, along with any osteophytes (bone spurs) or disc fragments compressing the spinal cord or nerve roots. Adequate decompression is confirmed under magnification or fluoroscopic guidance.

• Implantation of Artificial Disc: A metal-and-polymer prosthetic disc is inserted into the prepared disc space. It is sized and positioned to restore the disc height, allow normal neck motion, and reduce strain on adjacent levels.

• Closure and Recovery: The surgical site is closed in layers, often without the need for a drain. Patients typically recover faster than those undergoing fusion surgery and may be discharged within 24–48 hours.

• Postoperative Rehabilitation: Light activity is resumed within days. Physical therapy may be initiated to optimise motion and strength. Most patients return to normal routines within a few weeks.

Benefits of Artificial Disc Replacement Compared to Other Treatment Options

Artificial Disc Replacement offers significant advantages over traditional spinal fusion and non-surgical treatments. ADR provides long-term relief without compromising flexibility by preserving motion and reducing stress on adjacent spinal segments.

• Preserves Natural Motion: Unlike spinal fusion, ADR maintains movement at the treated level, preventing stiffness.

• Reduces Risk of Adjacent Segment Disease: Prevents excessive stress on nearby discs, lowering the chance of future degeneration.

• Faster Recovery Time: Advanced surgical techniques allow quicker healing and earlier return to daily activities.

• Lower Risk of Future Surgeries: Spinal fusion increases stress on adjacent vertebrae, often requiring further procedures, whereas ADR reduces this risk.

Improved Quality of Life: Relieves pain, restores function, and enables an active lifestyle with fewer limitations.

Will I Need Any Pre-Procedure Investigations?

Undergoing Artificial Disc Replacement requires thorough preparation to ensure optimal outcomes. Preoperative planning involves medical assessments, lifestyle adjustments, and informed decision-making. Following these guidelines enhances surgical success and minimizes potential complications.

Medical Evaluation

Before surgery, a comprehensive medical evaluation assesses your overall health. This includes reviewing your medical history, current medications, and underlying conditions that may impact the procedure. Blood tests and cardiovascular screenings ensure you are fit for surgery.

Diagnostic Imaging

MRI, CT scans, and X-rays provide detailed images of your cervical spine, helping your surgeon assess disc damage, nerve compression, and spinal alignment. These tests determine whether ADR suits your condition and identify the precise location for disc replacement.

Medication Adjustments

Certain medications, such as blood thinners, anti-inflammatory drugs, and supplements, may need to be adjusted before surgery to reduce the risk of excessive bleeding. Your doctor will provide specific instructions on which medications to stop or continue.

Lifestyle Preparations

Smoking cessation is crucial, as smoking delays healing and increases the risk of complications. Maintaining a healthy weight, staying active, and strengthening your neck muscles through prescribed exercises can improve surgical outcomes.

Informed Consent

Your surgeon will discuss ADR's benefits, risks, and expected recovery process and address any concerns you may have. Then, you will sign an informed consent form to confirm your understanding and agreement to proceed with the surgery.

How Does Artificial Disc Replacement Work?

Artificial Disc Replacement replaces a damaged or degenerated cervical disc with a biomechanical implant that restores spinal height and movement. The artificial disc consists of metal endplates and a mobile core that mimics the natural function of a healthy disc, allowing controlled motion between vertebrae.

The procedure uses an anterior approach, meaning the surgeon accesses your spine through a small incision in the front of your neck. The damaged disc is carefully removed, and the artificial disc is inserted into the space between the vertebrae. The implant is designed to integrate with your bone structure, providing stability without fusion.

Unlike spinal fusion, which permanently joins vertebrae, ADR preserves natural cervical motion. This reduces stress on adjacent discs, lowering the risk of future degeneration. Over time, your body adapts to the implant, restoring spinal alignment and function. Understanding how ADR works helps you appreciate its benefits as an alternative to traditional fusion surgery.

The Surgical Procedure: Step-by-Step

Artificial Disc Replacement is a precise surgical procedure designed to restore spinal function and relieve nerve compression. The surgery is performed under controlled conditions to ensure safety, accuracy, and long-term success.

Anaesthesia and Positioning

You will receive general anaesthesia to ensure comfort throughout the procedure. Once anaesthetised, you will be positioned on your back with your head stabilised to allow accurate access to your cervical spine.

Surgical Access and Disc Removal

A small incision is made in the front of your neck, allowing the surgeon to gently move aside muscles and soft tissues without damaging them. The affected disc is carefully removed using fluoroscopic guidance, creating space for the artificial implant.

Artificial Disc Placement

The artificial disc is inserted into the prepared space, ensuring proper alignment between vertebrae. The implant mimics natural disc function, allowing controlled motion while maintaining spinal stability. Once placed, the implant integrates with the surrounding bone for long-term success.

Closure and Recovery Room Monitoring

The incision is closed with sutures, and a sterile dressing is applied. You will be moved to a recovery room, where your vital signs are monitored as you wake from anaesthesia. Most individuals can sit up and move within a few hours, with discharge typically occurring within 24-48 hours.

How long does it take to recover from the surgery?

A well-structured recovery plan ensures a smooth transition from surgery to normal daily activities. Following post-operative care instructions and rehabilitation guidelines optimises healing and restores spinal function.

Immediate Postoperative Recovery

You will be monitored in the recovery room for a few hours before being transferred to a hospital room. Pain management strategies, including medications and cold therapy, help control discomfort. Most individuals can sit up and move within hours after surgery.

Activity Restrictions and Physical Therapy

Avoid strenuous activities for the first few weeks. A personalised physiotherapy plan will strengthen neck muscles and restore flexibility. Light movements, including gentle neck exercises, help prevent stiffness.

Long-Term Follow-up and Monitoring

Regular follow-ups with your spine specialist ensure proper implant integration and assess spinal stability. X-rays and MRI scans may be performed periodically to track recovery progress.

Returning to Daily Activities

Most individuals can resume desk jobs within two weeks and gradually return to physical activities. Avoiding high-impact sports and maintaining good posture are essential for long-term spinal health.

How to Know if I Am Eligible for Artificial Disc Replacement (Single or Two Levels) of the Cervical Spine?

You may be a candidate for this motion-preserving procedure if you suffer from cervical disc disease or herniation causing persistent neck or arm symptoms, and meet the specific clinical and anatomical criteria for ADR.

You are likely eligible if you have:

One or Two-Level Disc Disease:

Confirmed through MRI or CT scans, with herniated or degenerative cervical discs between C3–C7, causing radiculopathy (arm pain, numbness, tingling) or myelopathy (cord-related symptoms).

Failed Conservative Treatment:

Symptoms have persisted for at least 6–12 weeks despite medications, physiotherapy, or spinal injections.

Maintained Cervical Alignment and Mobility:

ADR requires adequate bone quality and normal spinal alignment. No severe curvature, instability, or facet joint degeneration should be present.

Desire to Preserve Motion:

Younger, active patients often prefer disc replacement to maintain natural spinal movement and reduce stress on adjacent levels.

Potential Risks and Complications of Artificial Disc Replacement

While Artificial Disc Replacement is a safe and effective procedure, like any surgery, it carries certain risks. Proper preoperative planning and postoperative care minimise complications, ensuring successful recovery.

• Infection: Although rare, any surgical procedure carries a risk of infection, which is managed with antibiotics and sterile surgical techniques.

• Nerve Injury: Precision techniques reduce the risk, but temporary nerve irritation may cause mild numbness or tingling.

• Implant Migration or Loosening: The artificial disc must integrate with the surrounding bones; improper healing may cause shifting.

• Swallowing Difficulties: Temporary throat discomfort or mild difficulty swallowing may occur, but usually resolves within days.

• Persistent Pain: While rare, some individuals may experience residual discomfort requiring additional treatment.

Why Should You Consider Artificial Disc Replacement at MIRSS?

Choosing the right hospital for spine surgery is crucial for achieving the best outcomes. MIRSS provides world-class expertise, advanced technology, and personalised care, ensuring optimal results for artificial disc replacement.

• Expert Spine Surgeons: Highly experienced specialists perform ADR using the latest surgical techniques and precision-guided technology.

• Advanced Diagnostic Facilities: Comprehensive imaging and diagnostic tools help determine the exact cause of your symptoms.

• State-of-the-Art Operation Theatres: Equipped with cutting-edge surgical systems to enhance precision and safety.

• Advanced Surgical Techniques: Modern surgical approaches ensure reduced recovery time, minimal scarring, and faster rehabilitation.

• Comprehensive Rehabilitation Support: Post-surgical care includes physiotherapy and personalised recovery plans for long-term success.

• Proven Track Record: MIRSS has successfully performed numerous ADR procedures, helping individuals regain mobility and improve their quality of life.