One of the most common conditions I see in our Neurosurgery Spine Clinic is neck pain and associated shoulder and arm pain due to a disk herniation. The cervical disks are the soft cushions between the vertebrae that act as shock absorbers and allow for movement of the neck. Occasionally, these disks will tear, leading to severe pain complaints or even neurological conditions with arm pain, sensory loss or weakness. When this occurs, neurosurgeons will frequently recommend removal of the ruptured disk if non-surgical treatments fail to improve things.
This surgery, called “anterior cervical discectomy,” is a minimally invasive and highly successful procedure which frequently allows patients to recover at home after an overnight stay. Most patients can return to light activity and even light exercise within a week or two. However, when the disk is removed, it is necessary to place a “structural support” between the vertebrae to keep the neck in normal alignment.
The standard structural support in the past was made by removing a small piece of your hip bone to fashion a new support. Over time, this bone (called autograft) would “fuse” to the adjacent vertebrae. Newer structural supports are made of cadaver bone (allograft) or high-grade medical plastics (PEEK cages). One issue with all three of these grafts is that by fusing to the spine, they reduce motion of the neck. Although this loss of motion is rarely noticed by the patient, the added stress on the spine can lead to degeneration of the adjacent levels many years or even decades down the road.
As such, in August of 2007, the FDA approved the first Disk Replacement for use in the United States. These disks allow for more natural motion and therefore have a theoretical advantage over fusion devises in preventing this “adjacent segment degeneration” in the years ahead.
During my training at the University of Washington, I was very fortunate to be a part of the official 2003/2004 FDA trial to study disk replacement and assisted in the placement of the very first artificial disk at the University Hospital in Seattle. Since that time, I have been a strong advocate for disk replacement and was one of the first surgeons in the US to be certified to place the disks since formal release in 2007. I have vast experience in placing these disks and have been on the forefront of obtaining authorization from insurance carriers in the private, public and labors and industries sector.
At this time, disk replacement surgery is only FDA approved for use at a single level which means if you have 2 or more disks that are torn or ruptured and need treatment, you unfortunately are not a candidate for this technology. Additionally, despite the wide base of medical literature to support disk replacement as an alternative to fusion, not all insurance carriers cover this technology. Here at the Spine Center we are experts in determining if you are a candidate and working with your insurance carrier to ensure you are covered.