Though not as prevalent as back pain, neck pain is still extremely common and afflicts millions of Americans every year. The vast majority of cases can be treated conservatively with physical therapy, activity modification, medication and various pain management modalities. If conservative measures are unsuccessful, then surgery can be quite successful in selected cases.
Traditionally, the majority of cervical spinal surgeries are performed by addressing the problem (usually a bone spur or herniated disk) through an incision made in the front of the neck, known as an anterior approach. The technique, by its nature, is minimally invasive, with little tissue disruption encountered to complete the task at hand. For decades, the procedure included removal of the disk or bone spur, combined with performing a fusion across the operated levels. For example, if the disk between the fifth and sixth vertebrae was removed, then the two bones would be fused together using a piece of bone or other graft, usually combined with a plate and screws to hold everything together.
This time-honored technique has been perfected by surgeons for decades with a high clinical success rate. However, potential drawbacks to a cervical fusion are loss of motion of the neck and transfer of stresses to nonfused levels. This may predispose the other levels to wear out more quickly, leading to additional surgery as one ages. In the 2000s, as technology evolved, many devices were developed to replace the old fusion surgery with an alternative to maintain motion across the operated levels in the cervical spine. Hence, the age of cervical disc replacement was born.
We were fortunate to participate in one of those early trials to determine whether this new technology would be as effective or even better than traditional methods. Eisenhower Desert Orthopedic Center was one of approximately 20 sites nationwide to participate in the Mobi-C cervical disk replacement trial. The device is made of two pieces of metal with a plastic core in between. It is “press fit” into the disk space, and various dimensions are available to ensure proper sizing.
We and our colleagues collected data on outcomes and submitted it to the Food and Drug Administration (FDA) for approval, which was achieved in 2013. The data indicated that the procedure is as good or better than a fusion in properly selected patients. We now routinely perform the procedure on properly selected patients with excellent clinical results. The FDA and Medicare have approved the device for one- and two level surgeries, and the private insurance companies are authorizing their use in selected cases too.
We have just completed data collection on patients who had the device implanted as long as 10 years ago and are delighted to see that the technology has stood the test of time. Most of our patients are candidates for a onelevel procedure, though some patients may need two surgical levels to fix the problem. Many of the patients having this procedure can go home the day of surgery (outpatient) and can resume full activities within six weeks following the procedure.
As surgeons, we always ask ourselves, “What would I have done if I had the same problem as you (the patient)?” The answer should be, “If this were my neck, I would have the same surgery I am recommending for you!” With our extensive experience with cervical disk replacement, the answer is easy and a resounding: “I would want a disk replacement if it is a viable option for me.”
