Innovative approach in cervical disc herniation surgery: Disc prosthesis

In recent years, there has been a new approach in the surgical treatment of cervical disc herniation, which is among the causes of neck pain that negatively affects daily life and sometimes manifests itself with complaints such as pain, numbness and weakness spreading from the arms to the fingertips. Disc prostheses, which are used especially in patients requiring surgery and have the ability to imitate the natural movements of the neck, are a treatment method that attracts attention with the advantages it offers. For details on the subject, Anadolu Health Center Hospital Department of Brain and Nerve Surgery Director Prof. Dr. We consulted Mehmet Çağlar Berk’s information. What kind of method is the disc prosthesis used in cervical disc herniation? Can it be applied to every patient? What are the differences from classical cervical disc herniation surgery? The answers to these and all your similar questions are in this article…

How Does a Hernia Occur?

Neck pain is a common condition today, especially among people working at a desk. These pains can sometimes indicate a cervical disc herniation in the most mobile part of our spine, that is, our neck. If recurring pain that does not go away with simple painkillers has reached a level that limits daily life, it is important to consult a specialist doctor for a definitive diagnosis without delay. The sections we call “discs” between the bones that make up our spine, on the one hand, maintain the distance between the bones from each other, and on the other hand, give our spine a certain flexibility, movement and load-bearing ability. Our spine makes all movements in our neck thanks to these discs. The disc can be compared to a small pillow. While the disc part is covered with a cartilage-like tissue, the inner part has a jelly-like consistency and consists of water, collagen and other protein compounds. However, this structure may lose its elastic properties due to loss of protein and water due to age. This is a situation that negatively affects the load-bearing capacity and flexibility of each disc in our neck. The result is, as you know, a hernia… Over time, the structure inside the disc bulges out of the disc and a hernia occurs. Hernia usually occurs in the neck and waist area; When the overflowing structure contacts the nerves, it manifests itself with complaints such as pain, numbness, tingling and weakness. Cervical disc herniation, which is rare in children, occurs mostly in the 30-50 age range, while degenerative problems such as rheumatism and arthritis become more prominent as age progresses.

Causes of Cervical Disc Herniation

• The elasticity and load-carrying capacity of the discs decrease with age.
• Heavy lifting and harsh neck movements.
• Traumas such as traffic accidents and falls, spinal injuries, unexpected sudden impacts.
• Posture-sitting disorders that occur unknowingly in modern life, especially when using smart technologies frequently.

Diagnosis and Treatment Process

For diagnosis, first of all, what the patient tells and detailed examinations are important. Listening to the patient well for answers to questions such as when the complaints started, at what intervals they appear, to what level of severity, in which movements/positions the complaints increase or decrease is a must for the correct diagnosis and the most appropriate treatment decision. While MRI, which shows both the spine and discs, as well as the spinal cord and nerve tissues in minute detail, is used for diagnosis, in some cases (if there are suspicions of conditions such as fractures, fissures, rheumatism) computerized tomography and x-rays may be requested. In particular, x-rays taken in various positions are used to see the limits of movement in the patient’s neck and whether there is any movement restriction. Apart from all these, during the diagnosis process, nerve conduction tests called EMG are also a useful method for some patients (for example, those with suspicion of diabetes or another disease affecting the nervous system) to distinguish whether the nerve damage is caused by a cervical disc herniation or another problem. It is possible to talk about non-surgical and surgical options in the treatment of cervical disc herniation. Non-surgical treatment options include painkillers and muscle relaxants, injections to the area where nerve compression occurs, physical therapy and chiropractic treatment. Among surgical options, disc prostheses have attracted particular attention in recent years with the advantages they offer.

What kind of precaution is disc prosthesis in case of cervical disc herniation?

The aim of the surgical treatment of cervical disc herniation is to remove the mechanical pressure on the nerve root and relieve the nerve root. When this pressure is removed in the early period, possible chronic and even permanent changes that may occur in the nerve tissue in later periods are prevented. When the treatment is delayed – even if the patient eventually undergoes surgery – the patient may not benefit from the surgery due to the damage to the nerve caused by this delay. Therefore, it is vital to decide what, when and how the most appropriate treatment will be for each patient. In surgical treatment, there are approaches that can be performed from the front or back of the neck. Surgeries performed from the back are based on indirectly relieving the pressure on the nerve caused by a cervical disc herniation by widening the channel where the nerve tissue exits using microsurgical techniques. In the classical surgery performed from the front of the neck, the disc between the two vertebrae is completely removed and the herniated part is reached and the nerve is relieved. After the overflowing part is cleaned, a piece of bone taken from another part of the patient’s body (usually from the hip) or plastic/metal cages are used to fill the gap between the two vertebrae. Afterwards, it is necessary to wait 2-3 months for the two vertebrae here to fully fuse together. After this type of surgery, the mobility of the neck decreases by 10-20 degrees for each level operated on. Although this loss does not generally cause a problem in daily life, over time, it increases the risk of cervical herniation due to increasing load and stretching at the upper and lower level of the operated distance. The medical name for this is “adjacent segment disease.” This risk is 2.9% for each year of life after classical fusion surgeries performed at a single level. Fusion at multiple levels further increases this annual risk. In other words, no matter how successful the cervical fusion surgery is, there is a high probability of having a second surgery sooner or later.

Nowadays, cervical disc prostheses are the preferred method in cervical disc herniation surgery in terms of both preserving early mobility in its most natural form without restriction and preventing the “adjacent segment disease” we mentioned. These prostheses are produced from light and very durable materials such as special plastic and ceramic alloys and titanium, which are accepted by the body and do not cause any allergic reactions.

Prof. Dr. Recently, Mehmet Çağlar Berk and his team have been performing cervical disc herniation surgeries with a high success rate at Anadolu Health Center Hospital using cervical disc prosthesis. Patients have the opportunity to regain their health and return to their daily lives as soon as possible after surgery. In addition, the health of the discs above and below the treated area is also preserved through surgeries performed with the cervical disc prosthesis, which preserves the neck’s natural movements, flexibility and load-bearing capacity.

How Long Does the Surgery Take?

The placement of the disc prosthesis used to eliminate the cervical disc herniation is completed with a 1-1.5 hour surgery. Patients usually stay in the hospital for only one day and are discharged the next day. In the first 1-2 weeks after surgery, patients are recommended to rest and avoid harsh neck movements. Afterwards, the patient returns to normal daily life and activities without any restrictions. Since there is no need to restrict neck movements even in the early postoperative period, there is no need for a rigid neck corset, which is often used after other surgical methods. This means additional comfort and convenience for patients.

Does Disc Prosthesis Stay in the Body Permanently?

The cervical disc prosthesis is permanent and durable, so it does not need to be removed or replaced in the future. Since it does not disrupt the natural movements of the neck and protects other healthy discs, it does not cause any restrictions in daily life for the patient.

Is It Also Used in Lumbar Herniation?

There are also prosthetic applications in lumbar hernia, but it is not yet as widely used as in cervical hernia.

Can it be applied to every patient?

Cervical disc prostheses are the most preferred treatment method today. However, sometimes – although rare – the patient’s neck anatomy may not be suitable for disc prosthesis. In this case, it is possible to use other treatment methods suitable for the patient.