CERVICAL DISC PROLAPSE.......The concepts about 'Artificial Disc replacement surgery'
Cervical disc prolapse often known as ‘slipped disc’ is a common cause of neck and arm pain. The disc consist of a tough outer fibrous layer that surrounds a gel-like nucleus. Repeated stress and over use of neck movements lead to degeneration of the fibrous layer causing the nucleus or gel to prolapse out and compress the nerve. This condition is more prevalent in the 30-50 age group, more so in machine operators, drivers and keyboard users.
SYMPTOMS AND SIGNS
The most common scenario for patients with herniated cervical disc is that the symptoms were present upon waking up in the morning, without identifiable trauma or stress. The herniated cervical disc usually impinges on the nerve exiting the neural foramen and causes pain and numbness over the arm, forearm and the fingers. If it is on the left side, it can mimic a Myocardial infarction (heart attack).
Almost all cervical disc herniations cause painful restriction of neck movements, especially extending the neck aggravates the pain. Some do get pain relief in elevating the affected arm and cupping the back of the neck or the top of the head. Some patients do exhibit an electric shock like sensation radiating on to the back between the shoulder blades. As the disease progresses, it can lead to paralysis of the upper and lower limbs & urinary incontinence.
DIAGNOSIS & TREATMENT
MRI is the radiological study of choice for the evaluation of a cervical disc proplapse. MR imaging offers more than 95% accuracy in diagnosing the problem and to look at the affected neural foramen and exiting root. Over 90% of patients with a cervical disc proplapse can improve without surgery, with the aid of adequate pain medications and cervical collar. Surgery is indicated in those patients who fail to improve with conservative management, and those who progressively worsen in their symptomatology while on medications. Microdiscectomy is the procedure of choice with or without instrumentation/bone graft. It gives good or excellent outcome in 90-96% of the patients. Cervical disc replacement (artificial disc placement) is a newer technology that has been in practice now, where the herniated disc is replaced by artificial disc thereby the range of movement is preserved at the disc space. Disc replacement surgery not only gives you a free range of movement, but also prevents stress on the adjacent vertebral bodies.
(X ray cervical spine showing ‘artificial disc’)
Dr. M. J. Arunkumar, M. Ch., DNB Senior Consultant Neurosurgeon Hannah Joseph Hospital Madurai