Houston Methodist. Leading Medicine

Neck FAQ

Question:

I'm trying to decide if I should have a painful disc in my neck removed and fuse the spine or replace the disc with a disc replacement. I've looked everywhere on-line for some direct advice which way to go but haven't found anything. What do you think?

Answer:

Pressure on the spinal cord or spinal nerves in the cervical (neck) region can cause painful disabling symptoms. This condition is called cervical radiculopathy. Usually, it's a herniated disc pressing on the nerve tissue that's causing all of the problems. When it comes to the treatment of herniated discs, for the most part, patients have several choices. First, conservative care can be tried. This may involve rest, activity modification, medications (pain relievers and antiinflammatories), and physical therapy. If you don't get at least 50 per cent improvement in pain within six to eight weeks, then it may be time to consider an epidural steroid injection (ESI). As the name implies, epidural steroid injection (ESI) is the injection of a numbing agent (like Novocain) and an antiinflammatory (steroid). A long, thin needle is used to inject the medication into the space between the spinal cord and the lining around the spinal cord. The effect of the injection is to block pain messages. It also decreases swelling that is putting pressure on the nerve tissue. A recent study showed that 80 per cent of patients who were considered good candidates for surgery actually got significantly better with ESI. And since ESI is much less invasive than surgery, patients with cervical radiculopathy should consider one to three injections first. Only 20 per cent of the group failed to get pain relief and ended up having follow-up surgery. In some cases, ESI was helpful but either the pain came back or some patients had pain relief but not total elimination of painful symptoms. In those cases, conservative care was prescribed including rest, change in activities, medications, and physical therapy. Only a small portion of the total patient group actually ended up having surgery. The take home message? Unless there is paralysis or a worsening of pain and/or other neurologic symptoms, patients with cervical radiculopathy should consider ESI therapy before surgery. If you have already gone through all of these steps and it is really the consensus that you need surgery, then the choice between discectomy (disc removal) with fusion and disc replacement is the next consideration. There are many advantages and disadvantages to each choice. The main difference between fusion and disc replacement is the preservation of neck movement. Only the disc replacement will maintain motion for you. Disc replacement for the neck is a fairly new procedure so if you go this direction, you will want a surgeon who is well-trained and has a good success rate. With either surgery, there are the usual postoperative risks of infection, poor wound healing, blood clots, and no change in symptoms. Surgical fusion doesn't always work and patients develop a false joint called pseudoarthrosis. Without the disc to protect the area, any movement at the spinal segment can lead to painful degenerative arthritis. In the case of the implant to replace the disc, there can be a shifting of the device or subsidence (implant sinks down into the bone). Your surgeon is really the best one to advise you as to what might be best for you. Your individual risk factors and predictive factors for failure/success can be explored and discussed. But if you haven't tried conservative care or epidural spinal injections, then this might still be the best place to start. Sang-Hun Lee, MD, et al. Clinical Outcomes of Cervical Radiculopathy Following Epidural Steroid Injection. In Spine Journal. May 20, 2012. Vol. 37. No. 12. Pp. 1041-1047.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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