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" describes the surgeon’s approach to the spine, through the front area of 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 will have fused into one solid piece of bone.
Q: What about artificial disc replacement?
A: A downside of spinal fusion is lost of mobility in the neck. Artificial disc replacement, also called arthroplasty, is an alternative to fusion that is designed to preserve motion (Figure 2). Clinicians also theorize that this newer technology can reduce the risk of adjacent segment disease, which can occur when a fusion imposes extra stress on the movable discs above and below the fusion. Over time, this added stress can degrade the adjacent discs, causing new problems. More long-term studies are needed to prove that artificial disc replacement truly reduces the risk of adjacent segment disease. Early studies do suggest that artificial disc replacement is comparable to anterior cervical discectomy and fusion (ACDF) in relieving symptoms caused by disc herniation and nerve compression.
The U.S. Food and Drug Administration has approved five artificial cervical disc replacement devices. You and your surgeon will discuss which one is best for your specific condition.
The majority of insurers in Ohio and Kentucky will cover artificial disc surgery if medical necessity requirements are met (i.e., single level; no prior fusion). Talk to your surgeon about whether you are a candidate for arthroplasty.
Q: If my insurance won't pay for artificial disc replacement, what out-of-pocket costs could I expect?
A: Insurance does not pay for everything. It may not pay for care that you or your health care provider think you need. For this reason we advise all patients to check with their insurance company in advance -- to make sure that both the device and the surgery expenses are covered.
If your insurance denies coverage of the artificial disc surgery, we will ask you to sign an Advance Beneficiary Notice of Non-coverage (ABN) stating that you will pay for any expenses not covered by insurance. The potential out-of-pocket costs for a cervical artificial disc surgery vary depending on the facility (outpatient surgery center or hospital). Our financial counselors can advise you on estimated costs.
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.