I am finally ready to put an end to my neck and arm pain. I have two choices: fusion or disc replacement. The surgeon is comfortable with either option for me. Is there any evidence out there that one is better than the other?
We are assuming that you have had adequate treatment following a conservative path before coming to the turning point to consider surgery
Most of the symptoms patients experience with neck instability (sensation of the head "clunking" with movement, headaches, neck pain, arm pain) go away with conservative care. Nonoperative treatment to address the contributing postural components, muscle weaknesses or imbalances, and other soft tissue issues should be given a fair trial.
But with degenerative conditions that don't respond to nonoperative treatment, surgical intervention to stabilize the unstable segment(s) may be necessary. Evidently, that's where you find yourself now.
In the past, the only real choice was neck fusion. And that worked "okay" (pain and other symptoms are relieved, the neck is stabilized) but there are problems with this approach. The biggest drawback is the fact that the patient loses neck motion at the fused level.
The subsequent problem is the increased load and force placed on the spinal segment above and below the fused level. The added stress speeds up wear and tear and can cause a condition called adjacent-segment degeneration. What's the answer to this dilemma?
Well, the next development in this area has been an artificial disc replacement. The procedure is referred to as a cervical disc arthroplasty or CDA. In theory, the implant is designed to stabilize the neck AND maintain motion without transmitting load to the adjacent segments.
How well is that working? A recent report of all the findings to date didn't come up with any firm conclusions. It's not just because one method isn't really working better than another. It has more to do with the way many research studies are designed and carried out. Without high quality research, the evidence gets downgraded.
Right now, the standard of care for cervical (neck) instability remains fusion. That's not necessarily because it is the best treatment approach for every patient. We don't have enough evidence to switch from fusion (with its known results) to disc replacement without better comparisons between the two.
If your surgeon feels you are a good candidate for either approach, then your decision is based on your goals, activity level, and expectations. Asking questions like this and searching for information will help you make the right choice for you.
Michael Zindrick, MD, et al. Cervical Disc Arthroplasty. In Journal of the American Academy of Orthopaedic Surgeons. October 2010. Vol. 18. No. 10. Pp. 631-637.
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