Q&A: Artificial cervical discs w/ Dr. William Tobler
Q: What are the early symptoms of cervical degenerative disc disease?
A: A patient with cervical disc disease first experiences mild symptoms, including a stiff or inflexible neck, low-grade pain in the neck, or neck pain that is worse in the morning, at the end of the day, and on cool, rainy days. Symptoms also can include numbness or tingling in the neck, arms, or shoulders. Changes in symptoms may occur slowly, over a period of years. As the disease progresses, the severity of symptoms may increase if there is increased pressure on the spinal cord. A patient with advanced disease may experience pain that radiates down the arm, shooting pains, loss of coordination in the arms and legs, and loss of fine motor skills.
Q: What are the standard treatments for cervical disc disease?
A: Non-surgical options for people with disc problems in the neck include rest, heat/ice, pain medications and physical therapy. When non-surgical treatment options fail, surgery is often the next step.
Mayfield neurosurgeons often treat cervical problems with an anterior cervical discectomy (the removal of the disc) and fusion of the vertebrae above and below the injured disc. The word "anterior" means that the surgeon approaches the spine from the front, through the area around the throat.
After removing the damaged disc, the empty space is filled with a bone graft (Figure 1). The graft is held in place with metal plates and screws. New bone cells begin to grow, and after several months, the two vertebrae have fused into a solid piece of bone.
Q: What about artificial disc replacement?
A: One of the downsides of spinal fusion is loss of mobility in the neck. New on the horizon is the artificial cervical disc, an alternative to fusion that is designed to preserve motion (Figure 2). The goal of this new technology is to maintain spinal motion after discectomy and theoretically reduce the risk of adjacent segment disease. After a spinal fusion, extra stress is felt on the movable discs above and below the fusion. The added stress can over time degenerate the adjacent discs and cause more problems. More long-term studies are needed to show if artificial disc replacement truly reduces the risk of adjacent segment disease. Early studies suggest that artificial disc replacement is comparable to anterior cervical discectomy and fusion (ACDF) in relieving symptoms caused by disc herniation and nerve compression.
There are currently three artificial cervical disc replacement devices that are FDA approved in the United States: the BRYAN® disc (approved 2009), the PRESTIGE® Cervical Disc (approved 2007), and the ProDisc-C (approved 2007).
The artificial disc is new technology that many insurers in Ohio and Kentucky are not yet covering. Still, the artificial disc is something that patients should ask their doctors about. It's likely in the future to play a role in the treatment of cervical spine problems.
Q: If my insurance won't pay for artificial disc replacement, what costs would I be responsible for?
A: Insurance does not pay for everything, even for care that you or your health care provider think you need. For this reason we advise all patients to check with your insurance company in advance -- to make sure that both the device and the surgery expenses are covered.
At Mayfield, we ask patients to sign an Advance Beneficiary Notice of Noncoverage (ABN) stating that they will pay for any expenses not covered by insurance. The potential out-of-pocket costs for a cervical artificial disc surgery varies depending on the hospital. Costs can range from $12,000 (outpatient) to $40,000 (inpatient). The artificial disc device itself costs about $4,500.
The information in this Q&A is not intended to be a substitute for professional medical advice, nor is it intended to serve as medical diagnosis or treatment. The information is presented for the sole purpose of disseminating health information. It is not intended and must not be taken to be the provision or practice of medical, nursing, or professional health care advice or services in any jurisdiction. Always seek the advice of your physician or other qualified health provider if you have questions regarding a medical condition, and always seek the advice of your physician or provider before starting any new treatment. The information about drugs contained in this Q&A is general in nature and is intended for use as an educational aid. It does not cover all possible uses, actions, precautions, side effects, or interactions of these medicines. As such, the information is not intended to serve as medical advice for individual problems or for making an evaluation as to the risks and benefits of taking a particular drug.
William Tobler, MD specializes in minimally invasive spine surgery and has performed several artificial disc replacements.