Category: Spinal Surgery

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ervical disc replacement is a minimally invasive thechnique to remove a degenerate disc and replace it with a moving prosthesis. The procedure can be performed as a day case procedure by our top spinal specialists.

Movement in the Cervical Spine helps to avoid adjacent-level disc degeneration

The cervical disc´s function is to absorb the loads to which the spine is subjected and to cushion the movements that occur between two contiguous vertebrae.

Regarding the factors that influence the appearance of a cervical hernia, we must differentiate between the acute-soft disc hernia that usually occurs in young patients and whose cause is usually traumatic, and the degenerative disc disease, in which the disk appears disc degenerated and dehydrated, and that is typical of cervical osteoarthritis.

The symptoms are of three types: cervical pain, pain referring to the extremities and spinal cord compression.

The diagnostic studies include first the radiography, an electromyogram (EMG), and finally a Nuclear Magnetic Resonance (NMR), which shows the condition of the discs.

What is cervical disc hernia surgery?

It is fundamentally based on removing the entire disc and replace it by a prosthesis. The approach is usually through the anterior aspect of the neck, separating all the prevertebral structures (carotid and esophagus). With microsurgery the disc is removed, the bone peaks are milled and the nerve or marrow is released. There are different techniques but all are based on removing the disc and replacing it with a prosthesis. Cervical hernia surgery performed by highly trained spine surgeons and is quite safe. If a single disc is operated, the surgery usually lasts 45 to 60 minutes, the next day the patient begins to be incorporated and is discharged on the same day or day after. Recovery is usually very fast and the scar heals satisfactorily.

Cervical disc replacement devices

Everything depends on the origin of the hernia: the mobile prosthesis is usually used in soft hernia in young patients without associated degenerative changes. On the other hand, the rigid prostheses are for the other cases or when there is medullar compression, in which it is sometimes necessary to remove one or more vertebrae or to place a plate with screws to favor the stabilization of the spine.

Cervical disc replacement vs. fusion

Recently, fusions have been performed to replace the intervertebral disc, which serves as a buffer between two vertebrae. However, the fusion technique involves adjacent disc degeneration, as a consequence of the increase in the workload suffered by the vertebra situated next to the fused one.

Increasingly, it seeks to preserve as much movement as possible in the spine through the use of prostheses in the intervertebral discs. Prosthetic replacement of the intervertebral disc is a booming technique, which has proven its effectiveness in the short and medium term.

Cervical disc replacement cost

Studies have shown that patients who underwent artificial disc surgery (arthroplasty) have been able to save an average of £4000 in the two years after surgery.

The initial cost of surgery, secondary procedures and medical devices per patient, as well as the cost of the initial procedure, were higher for arthroplasty patients than for fusion patients; however, those who received the artificial disc obtained long-term savings, because they needed fewer secondary procedures and returned to work sooner after surgery than the fusion patients.

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aser spine surgery is a new surgical technique that allows pathologies of the back to be operated through minimally invasive procedures.

It consists of making an incision of less than 2 millimetres that allows the spinal canal to be explored. For this, an endoscopic camera with a channelled optical mechanism connected to a high-definition television screen is used.

This system manages to introduce light and obtain a vision with a high-resolution image of the damaged areas of the spine, visualizing the intervertebral disc and the nerve roots with millimetre sharpness.

Through the optical channel, the different forceps and surgical instruments necessary for the treatment of different pathologies are used.

What are the advantages of laser spine surgery for the patient?
-It is a minimally invasive surgery that only requires a small 2-millimetre incision without scarring.

-It allows to enlarge and magnify the field of work.
-Relief from sciatic and lower back pain is immediate.
-The risk of injury, bleeding and aggression to the muscles is lower, so it reduces postoperative risks.
-Hospitalization is not required and is performed using local anaesthesia.
-Recovery time is reduced, allowing faster incorporation into the patient’s normal and work activity. The return to normal life occurs 24 hours after the intervention and, it is possible, to carry out a rehabilitation-only 15 days after the intervention.
-Postoperative drug intake decreases and even disappears in some cases.

In what pathologies is laser surgery indicated?
Herniated discs: It is the displacement of the soft centre of the intervertebral disc towards the outside due to rupture of the fibrous ring, being able to press on a nerve root or the medullary canal. Normally, herniated discs are located in the lumbar region, with the cervical discs (neck) being the second most affected area.

Lumbar canal stenosis: It is one of the ailments associated with age that normally appears from the age of 60 as people age. It is produced by irritation of the nerve roots that run through the spinal canal when, due to the degeneration of the discs and joints of the spine, the outlet of the nerves to the legs or back is narrowed. This narrowing is called stenosis.

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umbar fusion or arthrodesis is a technique that has been used for decades to solve instability problems in that region.

Since its inception, arthrodesis techniques have been modified for various purposes: to improve rigidity, to allow better correction of vertebral angulations, to increase the fusion rate, to be able to dispense with external braces, to decrease damage to healthy tissues, to reduce intervention time and bleeding, etc. But not all improvements can always be achieved at the same time, which is why several of the arthrodesis techniques are still in force, constituting a range of options for each case that arises.

TLIF technique
The TLIF arthrodesis, an acronym for “Transforaminal Intersomatic Lumbar Fusion” is a technique that allows both the anterior and the posterior part of the vertebral segment to be fused, but accessing only from one side of the vertebral posterior part. Therefore, it improves the fusion rates and the degree of correction in the same measure as the double accesses (anterior-posterior), but it simplifies the task and the risks when using a single approach and a single side.

Тhe procedure
Access to the disc (anterior part) is made through the neural foramen, that is, the hole through which each lumbar root comes out. But since the size of the foramina is insufficient to introduce implants, the technique requires removing the articular assembly (facets) and associating a fixation with pedicle screws. One of the disadvantages of TLIF is that manipulation of the neural ganglion in the foramen, especially when inserting the implant, can cause postoperative (usually transient) sciatica or long-term residual sensory discomfort. Postoperative sciatica is especially common after large corrections in height and disc displacement (spondylolisthesis). This problem gradually disappears in 5-7 weeks.

The advantages of TLIF
Because it is a foramen access technique, which allows a high degree of correction and ensures the success of the fusion, it is especially useful when it is necessary to reach the foramen (foraminal stenosis), when there are degenerative deformities (scoliosis and degenerative spondylolisthesis), or when the posterior fusion alone does not guarantee stability (isthmic spondylolisthesis). Due to its tendency to cause root discomfort in the postoperative period, it should perhaps be avoided in cases of pure lumbar involvement without canal involvement, thus avoiding any unnecessary neural manipulation.