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|Getting Rid of a
Pain in the Neck
by Carol DeFRank
EVERY YEAR. MORE THAN 200,000 people undergo cervical procedures to alleviate neck pain caused by compression on the spinal cord or nerve roots in the neck. For half a century the most common way to correct the problem was surgical fusion. Now, thanks to surgeons like Dr. Jaime Alvarez of Southwest Florida Neurosurgical and Rehab & Pain Management Associates in Fort Myers, patients can receive a revolutionary artificial cervical disc. This implant allows more natural movement and fewer breakdowns of adjacent discs, making it a state-of-the-art surgery when compared to the traditional procedure of fusion. Dr. Alvarez was the first surgeon in Southwest Florida to perform this surgery and, to date, is pleased with the rate of success hes experienced.
Dr. Brian Cummins of Bristol, UK, initiated the implant revolution by recognizing the faulty effects of multiple fusions in cervical spine patients who had degenerative disc disease. He developed the first artificial joint to replace the motion limiting, spinal fusion. Although there were several design- related shortcomings with the early prosthetic device, his concept sparked an innovation in the treatment of disc disease that is still evolving today.
In July 2007, Medtronic, Inc., the global leader in the spine market, announced that it received U.S. Food & Drug Administration (FDA) approval to market the Prestige Cervical Disc, the first artificial neck disc commercially available in the United States.
Studies indicate, when compared to spinal fusion, the Prestige Disc had superior neurological success, a measurement that included safety and effectiveness. The study also showed that fewer revision surgeries were necessary for patients who received the disc.
Dr. Alvarez says he uses the artificial replacement to maintain motion for patients suffering from the symptoms of disc disease or acute, unresolved, cervical disc herniation. It replaces a diseased or damaged disc and, most importantly, it maintains motion.
The disc is made of stainless steel, and has two articulating components (a ball on top and a trough on the bottom) that are inserted into the disc space and attached to the vertebral bodies on either side. Its design allows for flexion, extension, side bending and rotation of a natural disc. The patented device is available in a variety of sizes enabling the surgeon to match the patients anatomy.
During a recent interview, Dr. Alvarez explained how the new implant technology compares to the traditional fusion surgery.
Are you still the only surgeon in the area trained to do this surgery?
Dr. Alvarez: No. All the surgeons in our practice can now do it, as well as some doctors in other practices. Before any of us could perform the surgery, we had to be trained through a number of special courses.
When did you do your first implant?
September of 2007, I put one in a female in her 30s. Disc degeneration occurs more commonly in the older generation, but trauma such as a fall or accident, can cause a disc herniation or loosening of a disc that can lead to a pinched nerve in the working population or athletes. Since then Ive done five more.
Who is a candidate for disc replacement?
Anyone who has a disc in the neck that generates neck pain, numbness, tingling or weakness, in an upper extremity. Before we suggest surgery we usually try non-surgical treatment. If the patient is still having pain, surgery is usually recommended.
Who is not eligible for the implant?
Anyone needing more than a single level replacement or who has had previous cervical surgery at the treated level. Also, patients not skeletally mature, who have had a prior fusion, osteoporosis, chronic or acute renal failure or history of renal disease, is taking medications that could potentially interfere with bone/soft tissue healing and diabetics. There are others, but these categories make up the largest sector of the in-eligible.
How are patients evaluated?
They undergo an examination and MRI. We discuss the non-operative options including physical therapy and pain management. Following this course of action, a patient can still have pain, and thats when surgery is recommended. But there are patients who I see that are in excruciating pain and opt for surgery immediately. They may be showing signs of weakness or paralysis.
Why use an artificial disc in the neck rather than the tried and proven method of fusion?
Once you fuse a disc, you lose some degree of motion in the disc, as well as in the neck. Its that rigidity that we feel leads to the adjacent segments degenerating. Also, following a fusion, the levels of the discs adjacent to the fused segment tend to degenerate within a few weeks or months and the patient acquires new problems. An MRI may demonstrate that the discs adjacent to the fusion are worn out, collapsed, and/or herniated. Studies have shown that by maintaining or preserving the normal motion of the spine after removal of the disc, which the implant does, we could prevent adjacent segment degeneration. This preserves the normal motion of the spine.
Is there ever a time when you would still recommend fusion?
Yes. If the neck is falling apart severely, and is so degenerated that it needs reconstruction, wed stabilize it with a fusion rather than artificial discs. Another example is if the patient needs more than one fusion.
What makes this process so revolutionary?
The neck is not a ball and socket joint like so many other parts of the body, so motion is different. It took a lot of research to determine the true motion of the spine, and then replicate that with an implant. This surgery offers patients suffering from degenerative disc disease the potential to preserve motion at the treated level, as well as pain relief and function.
How long does the surgery take?
An hour to an hour and a half.
How long is recovery time and how does it compare to recovery of a fusion?
Approximately six weeks. Its a progressive improvement. People are commonly back to work before that. Theres no need for bracing or wearing collars. We want patients to move their heads and neck as normally and as soon as possible. A fusion immobilizes the patient because a brace is necessary; therefore mobility is limited thus prolonging their inability to return to normal routines, including work.
What are some of the complications of implant surgery?
The same as those with a fusion. For either surgery we enter through the front of the neck. We work around several vital structures such as the esophagus, the carotid artery and the spine, where theres always a small risk of paralysis. The overall rate of complications is in the single digits.
Is the procedure covered by health insurance?
Most insurance companies are beginning to cover it. But it is a new technology, so the process of authorization and acceptance is ongoing.
How does the cost compare to a fusion?
Its about the same.
Will there be approval for more than one level anytime soon?
The newer generation of the Prestige disc is expected to be smaller which will allow for side by side implants.
For more information, call Southwest Florida Neurosurgical and Rehab & Pain Management Associates at 432-0774.
from the May-June 2008 issue
Dr. Jaime Alvarez