Questions Wise Patients Ask Their Doctor Before Cervical Disc Replacement

The disc is a soft cushion-like structure between the individual bones of the spine. In most cases, a disc is quite flexible and allows the spine to bend. Disc replacement is defined as the removal of the damaged spinal disc, followed by insertion of an artificial disc between the vertebrae. The artificial disc mimics the functions of a damaged disc, that is, to carry a load and help in motion.

Artificial discs are mostly made from metal- or plastic-like (biopolymer) materials or a combination of both. Artificial Cervical Disc Replacement is needed when the pain arising due to degenerative disc disease or any other disorder is not relieved through non-invasive methods such as medicines, injections, chiropractic therapy, or physical therapy.

The type of artificial disc to be used depends on the cause of your back pain, the severity of the pain, and the comfort or experience of the surgeon. The various indications for disc replacement include:

• Degenerative disc disease
• Back and leg pain
• Degenerative scoliosis
• Disc-related back pain
• Post-facetectomy syndrome
• Failed previous surgery
• Unstable spinal stenosis
• Isthmic spondylolisthesis
• Degenerative spondylolisthesis
• Segmental instability

Your surgeon will correlate the results of your investigations with conclusions from your history and physical examination to find out the source of your pain. However, not everyone can undergo a disc replacement procedure. Your doctor will determine the best treatment for you based on your medical condition. Disc replacement cannot be done in patients with osteoporosis as they do not have strong bones to support the procedure. Also, it is not considered as a highly successful procedure in patients who are aged 50 and above.

Before the surgery, your doctor will discuss the detailed procedure with you and answer your doubts and queries. Some questions to ask your doctor before getting ready for disc replacement to include the following:

Q. Why do I need disc replacement surgery?

A. It is important to talk with your surgeon about the purpose of your surgery and how it is related to the diagnosis of your spinal problem. For example, you must understand why it is recommended – to relieve pain, improve functioning, or improve the symptoms?

Q. Are there any other alternatives to disc replacement surgery?

A. For most spinal conditions wherein the pain is not relieved by non-invasive methods, spine surgery is the only option. The type of spine surgery that the doctor decides to conduct may depend on the ailment or the root cause of the pain. The most common alternative to disc replacement is microdiscectomy followed by spinal fusion. However, talk to your surgeon if he/she knows about other options or if there is any reason to try a different kind of treatment or postpone the procedure.

Some of the most commonly known alternatives to Disc Replacement is as follows:

• Spinal Fusion Surgery: Spinal fusion surgery is a type of spinal procedure used to join two or more bones permanently in the spine and prevent movement between them. The bones that are joined are called vertebrae. Spinal fusion surgery is performed along with other surgical procedures such as foraminotomy or laminectomy and after diskectomy in the neck. It is required if the patient has an injury or a fracture of the vertebrae.
• IDET or Intradiscal Electrothermal Coagulation:  This procedure involves inserting a needle into the lumbar disc space, passing a catheter through the needle, and heating up the annulus (the outer core of the disc space).
• Posterior Dynamic Stabilization: This treatment is different from fusion in that posterior dynamic stabilization seeks to preserve motion in the spine while also taking pressure off the diseased vertebral disc.
• Disc Regeneration: Researchers in cellular and molecular biology are exploring ways to use gene therapy to stimulate regeneration of the vertebral disc and/or to slow or prevent degeneration of the disc.

Q. What are the benefits of having a disc replacement?

A: Ask your surgeon what benefits you will experience after the disc replacement procedure. Also, ask why disc replacement is a better option than microdiscectomy or spinal fusion and vice versa. You should ask when can you return to work again and whether you will live a pain-free life after the surgery. You should seek knowledge of how long these benefits will last or if you will need to undergo another surgery after some time.

Q. What are the risks involved in disc replacement procedures?

A: All surgeries carry some risks of developing certain complications such as infection, excessive bleeding, and nerve injury. In addition to these, disc replacement can also lead to complications such as sensitivity to the material of the artificial disc, breakage or wear and tear of the disc’s components, dislocation of the implant, damage to the vertebra where the disc replacement was done, or failure of improvement after the procedure. Your surgeon will discuss all the risks involved in the procedure.

Q. What if I choose not to undergo disc replacement?

A: After you have learned all about the risks involved, ask your surgeon what will happen if you choose not to undergo the procedure. You can ask question such as will your condition worsen or will you experience even greater pain than what you have?

Q. Can I have an MRI after having an Anterior Cervical Discectomy and Fusion?

A: MRI or CT scans are performed on people that have undergone a spinal fusion surgery with titanium implants to rule out re-herniation or to aid the physician to understand the condition post-Cervical Disc Replacement Surgery. Always inform the imaging technician performing the MRI or CT scan that you have undergone spinal replacement.

Q. Have you completed a fellowship in spine surgery?

A: It is important to note that only an orthopedic or neurosurgeon should perform spine surgery. Anyone performing a disc replacement procedure should have completed a fellowship in spine surgery. Ask your surgeon whether he/she has completed a fellowship.

Q. What has been your experience with this procedure?

A: Ask your surgeon about how many disc replacement procedures he/she has performed before. Try to understand his or her experience in the management of the condition that you have and the procedure. Ask your surgeon for any references to a person who also had disc replacement done.

Q. What is the overall success rate of disc replacement and what is your success rate?

A: No surgery is 100 percent successful. Ask your surgeon what is the overall success rate of the disc replacement procedures and what has been his personal record. Both numbers should be close to one another.

Q. Do you collect any data for research or to track your patient outcomes or complications?

A: Ask your surgeon, if he/she has a track record maintained for previous patients on whom he/she carried out the disc replacement procedure. Ask for the complications as well as outcomes of the procedure carried out on the previous patients.

Q. Do you perform the entire procedure or will there be a team involved?

A: Some surgeons perform the entire disc replacement procedure from start to finish on their own, while others work with a small number of team members. Ask your surgeon who all will be in the operating room and what will be their respective roles.

Q. Where will the disc replacement be performed?

A: Since most surgeons work in more than one hospital; ask your surgeon where the procedure will be carried out. If you are given a choice, choose the facility that has the most experience and high success rate in treating the condition that you have. Ask your surgeon whether or not your procedure will require you to stay in the hospital and for how long.

Q. How long will the entire procedure take?

A: Ask your surgeon about the total duration of the disc replacement procedure. Most artificial disc replacement procedures take about 2 to 3 hours.

Q. How long will it take for me to recover from Artificial Cervical Disc Replacement Surgery?

A: Ask your surgeon how long will be the recovery period after disc replacement. Ask him how long it will take to return to regular daily activities. Also, ask your surgeon about any special precautions that you need to take after surgery, any medications, and the walking or exercise regimen you need to follow. It is good to ask when you can resume your sports or other kinds of physical activities.

Q. Will there be any kind of pain after disc replacement and for how long?

A: Ask your surgeon about all kinds of side effects that can occur after the disc replacement. Also, ask if there will be any pain during the recovery period and for how long. Ask him/her if you can take any special measures to manage the pain.

Q. How much follow-up will I need after the procedure?

A: Ask your surgeon the level of follow-up required after disc replacement. Usually, patients follow up at four to six weeks after the disc replacement surgery, and then at three months, six months, and one year after the surgery. However, your surgeon will advise you to follow-up, up based on your specific condition.

Q. If I want to get a second opinion, who would you recommend?

A: Ask your surgeon, where you can get a second opinion regarding whether to have this surgery or not. This is to ensure that you are making the right and informed decision. You can also take an Expert Opinion from our Advisory Panel consisting of 20+ Doctors with experience in performing complex surgeries on International Patients on a day-to-day basis.

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