Cervical Disk Arthroplasty (Disk Replacement) Explained

**CLICK SHOW MORE FOR IMPORTANT ADDITIONAL DETAILS**
Hello friends, today I'm bringing you a video overview of the cervical disk arthroplasty or disk replacement procedure. This is a new exciting procedure and is likely to be the future of spine surgery in the neck because it helps maintain the motion of your spine. Right now it is reserved for select patients but that should expand as time goes on. The benefits of this procedure is less odds of re-operation compared to the traditional ACDF. I perform this procedure to help patients with neck pain and pain going into their shoulders, arms, or hands. This surgery has an outstanding success rate. Learn more about it in the video above.
I'm a board certified orthopedic spine surgeon proudly serving the people of the Bradenton/Sarasota/Lakewood Ranch, FL area in a multi-specialty orthopedic group called 360 Orthopedics (www.360-orthopedics.com).
Timestamps:
00:00 - Intro
00:50 - Anatomy and Overview
07:36 - Surgical Procedure Steps
11:42 - Symptoms, Causes, Expected Recovery
17:43 - Conclusion
For A Consultation:
- Please call 360 Orthopedics at 941-360-2233 and ask for Dr. Armaghani
- Go to www.ArmaghaniSpine.com and click "Book An Appointment"
Office Locations - 360 Orthopedics
1. 5985 Silver Falls Run, Suite 101
Lakewood Ranch, FL, 34202
2. 2750 Bahia Vista St, Suite 100
Sarasota, FL, 34239
Other Related Videos:
Cervical Radiculopathy - • Cervical Radiculopathy...
Cervical Myelopathy - • Cervical Myelopathy - ...
ACDF - • ACDF (Anterior Cervica...
Websites:
www.ArmaghaniSpine.com
www.360-orthopedics.com/sheya...
Other Platforms:
Twitter: / armaghanispine
Facebook: / armaghanispine
The content on this KZbin video and channel, including, but not limited to, the text, graphics, images, links, and other materials are for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment, and does not constitute medical or other professional advice. Dr. Armaghani does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the website. Reliance on any information provided herein is solely at your own risk. The information provided on all websites associated with Dr. Armaghani, including www.ArmaghaniSpine.com, is designed to support, not replace, the relationship that exists between patient/site visitor and his/her physician. Never disregard professional medical advice or delay in seeking it because of something you have read or seen on this KZbin page or on www.ArmaghaniSpine.com.

[@pilarsalazar4353]

I will be having this exact surgery in a few weeks , I had so many questions, thanks to this video my question were answered, Thank you Dr. Blessings 🙏🏽

[@donkeywhistler]

How did you do?

[@aprilgideon4093]

Just had this done a month ago. I’m feeling a lot better now. Thanks for this wonderful video 😊

[@dompav4478]

Thank you Doctor, you are so precise with the procedure.

[@margaretrefile8207]

Thank you for this information

[@lynnrose1129]

Excellent over view! Thank you

[@ArmaghaniSpine]

Glad you liked it!

[@susanm8975]

Thank you for these videos. Im scheduled an ACDF and ADR a week from tomorrow.

[@ArmaghaniSpine]

good luck!

[@robinshepard4571]

Appreciate it 🇺🇸

[@gaitreerangasammy4938]

Thanks for explaining, I’ll be getting the same surgery & im very scared

[@narrissajackson3869]

Smart presentation

[@ArmaghaniSpine]

Glad you think so!

[@debbe9553]

Dr., thank you for such a concise breakdown of the surgery I am to have in the next three weeks. This is very helpful. Do you have a video on recovery process? My surgeon gave me 2 neck braces to use, a soft one and a hard one. I have just printed out neck exercises to strengthen my neck muscles before I have surgery. Any answers will be greatly appreciated. Thank you. Debra

[@eloysuarez364]

hello Dr. thank you for the informative videos. I have two questions if you don't mind: is this procedure appropriate for multi-level disease? is cervical myelopathy an indication for this procedure ? thank you for your time.

[@kasimirb5155]

Very precise and detailed information and an honest evaluation of the procedure. This was very helpful. Thanks. Can you do the same surgery on lumbar discs?

[@ArmaghaniSpine]

yes but we have a bit more difficulty getting insurance approval than with cervical disks.

[@pauldunn9871]

Great video! Do you use that burr to remove the rear bone spurs as well?

[@josephdileonardo409]

great video. very informative. Is a disc replacement something that is recommended if the facet joints at the replacement level are moderately arthritic? 33 year old male asking. Thanks

[@lindav1189]

you are a very good teacher. You said your patients take pain medications for a few weeks. Do you mean tylenol and nsaids, or prescription pain meds?

[@echidnaspikes8563]

Thank you for such a detailed information, Dr. Armaghani! I am 41 y.o. and got diagnosed with cervical radiculopathy after whiplash car accident related injury a year ago. I was told that my c6-c7 is herniated but does not compress the spinal cord. However despite physical therapy and 2 epidural steroid shots I am in constant neck pain, this treatment only affects my range of motions. How many steroid injections are considered as a usual protocol before thinking about a surgery if any surgery is even appropriate in such cases?

[@jerryrobinson7856]

Hi Doc. Shehan. You asked me to review this video. I will say its the most reasonable way to explain to a patient what will happen in and TDR (Total Disc Replacement) procedure. Some will say its long and TMI, but I say its responsible and a good job. Resource: Seattle Spine Institute has some interesting surgeon to surgeon discussions including one with Dr. Blumenthal from TBI (Texas Back Institute). In that he had the Prodisc 5 year [patient results showing ASD at 28.6% for fusion patients and 9.2% for TDR. Some history... When I went to Dr Clavel in Barcelona (my ADR neurosurgeon) he explained is another factor that led them to use either the Spinal Kinetics M6 or the LP-ESP discs because these have a cushion like center nucleus to also immolate a human disc that can not only restore 6 degrees of angular mobility, they act like a shock absorber. They wont use a metal on metal implant as it can overwork (movement priority is the ball and socket first to move left and right) and even overextend the facets. The biggest problem was metal on metal transfers a great amount of unmitigated energy (walking, running, living, etc.). This metal on metal leads to increased friction ASD. So one has to ask, what is best in the long run for TDR candidate patients? Europe has been about 15 years ahead of the US for a variety of reasons starting with the TDR being invented at the Charite Hospital in Germany Circa Mid-1970's. The US has been dominated with mega-manufacturers like J&J/DePew, Striker, etc. It cost $14 million to get a disc approved and years and years. What has actually happened is excellent manufacturers like US Spinal Kinetics went to Europe first for CE approval which was received well, got approved and cost less to get approval. Furthermore, the CE approval is honored medically around the globe of as a fast-track into other Country's including Russia and India. Think about the fact that Europe is a 740 million person market and the US is only 330 million and way more costly, far more push back, lots more time. The epicenter of knowledge in Europe has pushed TDR's for about 3 decades now and perfected it 15 years ago. I just watched a youtube video of a surgeon in Beverly Hills in 2019 being the first surgeon in the US to perform a double level Spinal Kinetics M6-C in the US. I had the M6-L in 2016 and the two ESP's cervical in 2018. At the time Dr Clavel had already performed 550 lumbars TDR's and 2100 Cervicals of which 80% were double level. He had only two revisions, one post menopausal bone density problem (years ago before they tested for this) and another was a woman who claimed an unstated allergy. If I were a bright young spine surgeon, I would be paying significant attention to the ESP and Spinal Kinetics TDR's. Both of these are "standards" in the top spine surgeons experiences for over 12 years now. I really appreciate the design of the M6 as every possible consideration has been addressed: 1. Decompression; 2. Center nucleus with a cushion; 3. Bands that stretch and allow cadence of movement of the facets (no faster to turn ball and socket); 4. A true 6 degrees of natural spinal movement. Another great surgeon to watch videos from in John Hsiang also at Seattle Spine. He has one about 4 years old where he explains the extreme differences in carpentry skills for TDR's versus chapping and growing bone away in a fusion are at extreme opposites. I would rather offer the best that Europe has proven as excellent and people will love recommending you. The M6 and the ESP are the standard of the best of the best. Best always. Jim

[@ArmaghaniSpine]

Thank you for the kind words, Jim. The M6 implant does have a great track record so far and we are constantly keeping an eye on the long-term outcomes and biomechanical studies to help minimize the odds of adjacent segment disease.

[@jaguarreal9116]

Informative reply. Can you recommend other Neck-Spine-Neurosurgeon doctors in North Texas. I have multi-level issues, on my first visit, my neurosurgeon indicated I need C4 ACDF. But considering progression of ADS, i.e. future need on other levels, perhaps I should push for TDR. I am 61 yrs old, cardio-very-fit, symptoms are mild. I am also surprised that he said C4 when the MRI report says: I noticed TBI are ortho. What are your opinions on ortho vs neurosurgeon? 3. C4-5, 3 mm central disc protrusion causes mild spinal canal stenosis. Moderate degenerative left foraminal stenosis. 4. C5-6 and C6-7, severe bilateral foraminal stenosis. Mild disc height loss.

[@jaguarreal9116]

@@ArmaghaniSpine Hello Doctor. Pleasy jump in on my comment to Jerry. Some repeat here I am 61 yrs old, cardio-very-fit, symptoms are mild. I am surprised that on my first visit with my neurosurgeon, he said I need ACDF on C4 when the MRI report says below. Also, it seems prudent that with multi-level issues, that my first surgery be TDR with expectation of some future adjacent progression. What are your opinions on ortho vs neurosurgeon? 3. C4-5, 3 mm central disc protrusion causes mild spinal canal stenosis. Moderate degenerative left foraminal stenosis. 4. C5-6 and C6-7, severe bilateral foraminal stenosis. Mild disc height loss

[@brians2328]

2 level lumbar lp-esp in the house, and in a few days will have 1 level cervical cp-esp, best decision of my life! I have spent significant resources to ensure the rest of my life are hopefully problem free! I agree, the fda and insurance companies have slow walked Americans for decades, leading people with DDD to suffer, and forced many others into fusions. I have lost jobs so many times I can't count, they wouldn't do anything but Steroid and pain meds. It nearly destroyed me after over a decade.. Finally I figured out Europe (Germany) had the answer, now I'm on my 2nd and hopefully final surgery, no regrets! But I have a fair amount of animosity towards the American system of treating back pain! My neurosurgeon in Germany couldn't believe how long I suffered or the other procedures (spinal cord stimulator) I was forced into. So many others were forced into a fusion, I thank the heavens that was not me!

[@jerryrobinson7856]

@@brians2328 Wow, what a story. Last December I had 7 cervical facet laser (permanent) ablations and I am in Physical Therapy to correct my kyphosis (forward neck posture). Insurance picked up some. But it was more concierge and with flight and hotel I paid $25,000 out of pocket. My point is, I was told my facets were "not pristine" when I went to Barcelona for my two cervical ESP discs in 2018. So it was not a surprise. One surgeon to pay attention to is Dr. Ara Deukmagjion (Dr Deuk at Deuk Spine in Florida. The behind the door expression with spine surgeons is "they call it back pain because you will be back". No one wants to have further issues. But it's wise to stay attune. Best to you my co-buddy.

[@johndoriano4796]

Hi doc goodmorninv. Watching from the Philipines. My question is that, at what condition you have to perform this way of surgery?

[@hanaaalmansoob6827]

Woooow; Fantastic, I have this surgery on coming month of October; I have in C4, c5 and C5, c6. Thank you for all this presentation and clarification 🙋🏻‍♀️🌺💞

[@ArmaghaniSpine]

Good luck!

[@REDward27]

Thank u for the very clear discussion/explanation about my illness radiculopathy. I am greatly enlightened and i was given a positive ensignts with a chance to recover from sufferings from pain. At this point in time, i am now on my 10th session on my PT but still i fell discomfort, can i proceed to esteroid injection? Whose doctor can do this?

[@ArmaghaniSpine]

A PMR (Physical medication and rehabilitation) or a pain management doctor is capable of providing injections.

[@freakyaussy]

What is the cost of this surgery and do you know if I can have this done in Australia

[@user-mp4zl2qo2h]

Would you consider this for an older patient with scoliosis and nerve impingement?

[@PlaneImpactGolfStoneridge]

What determines a fusion vs artificial disc replacement ?

[@islamomran1355]

Thank you much for this great video! I have c4-C6 fusion but now having c7 and C8 nerve root impingement. Can I do disc replacement below a fusion? Also, what are your thoughts about cervical traction at physical therapy using saunder cervical traction?

[@ArmaghaniSpine]

traction works great as a nonoperative measure. if that an PT fail, injections are possible. you can do a disk replacement below a fusion but some insurances (Cigna in particular) do not allow it as they see it as "experimental"

[@carlosontiveros430]

How many replacements can be done at one time? I have 5,6,7,8 budged disc and degenerated.

[@Ishgishnjj]

Hi Dr. Armaghani - I will be having a disc replacement for C4 ,C5, C6 and C7 stenosis. There is significant pinching of the spinal cord. I also have Normal Pressure Hydrocephalus and those associated problems. We are all hoping that this is the obstruction preventing Spinal Fluid draining and in repairing it, it will resolve the NPH. Any thoughts? And thank you, your video is outstanding.

[@peny1981]

How are you feeling after operation ?

[@kaelindejesus6670]

Please share how are you feeling after surgery?

[@grahamsmith7407]

Hi Doctor Armaghani, great video as usual. I am experienceing neck pain as well as feeling pain that goes into the front of the head should this be of any concern? I had a brain and cervical MRI around 3 months ago that showed nothing sinister was present? Any thoughts please?

[@ArmaghaniSpine]

Thank you for the kind words, Mr. Smith. Without a structural issue which would show up on an MRI of the cervical spine and brain, it is unlikely that a surgery would reliably fix those kind of problems. This could be a type of headache possibly as well which maybe should be evaluated by a neurologist. There are some people with pain like you experience who have seen good results with botox injections in those areas and the good thing about that is that it isn't a surgery. good luck!

[@grahamsmith7407]

@@ArmaghaniSpine thank you very much for the prompt reply, Kind regards, Graham

[@fardeenburhan221]

Hello Dr. which one is better ACDF or ADR for C5-C6 disk bulge or herniation, which already once gone uder the surgery now after 4yrs same pain, tingling, on shoulders and in between shoulders started also stress on face and head region.

[@ArmaghaniSpine]

Very good question and that is a question many surgeons argue about which is better. In my opinion, I think getting a cervical disk replacement is preferrable to an ACDF. However, not all patients are candidates for a replacement. They can't have as much disk degeneration, arthritis, and their bone needs to be reasonably strong. That would be a good conversation to have with your local surgeon.

[@nikkyshairades9078]

I am new here,please what test should I get for my C4 C5 that sticks out and causing me burning pain?

[@ArmaghaniSpine]

MRI of the cervical spine is the best test to evaluate the disks, spinal cord, and nerves.

[@pickleballnic]

Hi Doc... what are your thoughts on bookending an ACDF with ADRs at the levels where the discs are starting to degenerate due to adjacent disc disease from the fusion? Have you done a surgery like this? Any feedback would be greatly appreciated.

[@ArmaghaniSpine]

I love the idea and would do it much more frequently but insurance (especially commercial insurance) will almost never approve it.

[@fladay3928]

@@ArmaghaniSpine I’m getting ready to do this I had c5-6 fused now going to have c3-5 done with the mobi-c . Didn’t really want to do it at all but at least I’m able to use the artificial disc this time insurance company okayed it to FYI

[@Raj-ul9my]

Hi dr, i had c5/c6 spinal cord compression and same level nerve root compression for about 2 years as i started with conservative treatment. My symptoms got slightly worse and worse and i decided to have a disc replacement. The good news was that although my cord was been compressed a lot on the mri scan showed that their was no evidence of myelopathy or any white lesions on my spinal cord. I have no bowel issues or balance problems. I had some arm pain and headaches. After surgery i see a big improvement already after 2 weeks, its possible to make a good recovery as no sign of cord damage? And when nerves heal does the pain signals go away? To your brain?

[@ArmaghaniSpine]

I'm glad you've had such a good result! Complete recovery of nerves takes about 1 year so how you feel at 1 year will be how you feel long term. Usually pain improves pretty quickly after surgery but weakness and numbness takes a lot longer to get better. Hang in there!

[@Raj-ul9my]

@@ArmaghaniSpine thank you, however I might need a fusion as my neck pain had not gone away?

[@johnwalters7502]

Similar to any bone spurs removed at the anterior aspect of the vertebral body, are bone spurs at the posterior aspect of the vertebral body also removed? At the front, how do you deal with the anterior longitudinal ligament in order to remove any bone spurs? Is it pushed aside, cut/dissected? Thanks.

[@ArmaghaniSpine]

Fantastic questions. Yes, we do remove the posterior bone spurs and those are most important as they are the culprits in terms of compressing nerves. As for the ALL we do remove that in the process of removing the disk. There is also a posterior longitudinal ligament which is the last covering from the disk to the spinal cord and that is typically removed as well to ensure the spinal cord and nerves are adequately decompressed.

[@johnwalters7502]

@@ArmaghaniSpine Thanks; much appreciated!

[@bmp713]

Is it required to cut through the anterior ligament to remove and replace the discs? Is it required to remove the PLL if there is cord compression? How much does the disc replacement add stability to make up for cutting the ligaments? I wonder because it seems these ligaments are very important to maintain stability after surgery. The research seems very conflicting on whether the ligaments should be cut.

[@peny1981]

Can (during ADR) posterolateral bone spurns be removed?

[@ArmaghaniSpine]

Yes, absolutely. That is part of the work we do before the disk replacement is placed. We remove all the bone spurs and material that could be touching the spine.

[@SuperEve75]

Poor people don't qualify for this, I wanted this procedure done but medicaid only approved the old version where my neck is now stiff, now I wonder if I could afford this one day , can my old surgery be removed and replaced with this one?

[@ankitkohli-pw3hc]

Hey doctor what is the sucsess rate of of cervical DR surgery bcs my age is just 21 years and i have problem on c3,4 c4,5 c5,6

[@ArmaghaniSpine]

Patient satisfaction as measured by asking patients at 1 year 2 questions: 1) Are you happy with your outcome and 2) If given the chance to do surgery again would you. Satisfaction is about 85-90%

[@AR-rf8vo]

سلام دکتر،من سی و چهار سالم هست و سه تا از دیسک،های کردم پاره شده دکترها می گن باید جراحی کنم و دیسک مصنوعی بذارم بعد از این کار می تونم ورزش کنم؟ بندسازی و مویتان کار می کنم

[@ramonesmith2864]

Hello Doc,where r u located?

[@ArmaghaniSpine]

orlando, FL

[@Weiyang5268]

👌10:31 11:47

[@MdRokibulHossainMukul]

Hi, I am Md Rokibul Hossain from Bangladesh, I am suffering with Ankylosing Spondilities from 14+ years. Didn't move my neck because My survical disc (c1,c2,c3) fused, want to know is it possible to resolve?

[@ArmaghaniSpine]

ankylosing spondylitis is, unfortunately, not a condition that can be alleviated effectively by surgery, however, medication through a rheumatologist can help in preventing further progression.

[@CYALLC]

If you want to chat with me about AS I have it too for many years. Am going to see Dr Armaghani in 4 weeks. My AS is not a severe as many others but just at age 47 I had imaging and it shows DDD in the Cervical involving C2-C3-C4-C5-C6 but not 7 or 1. I lost most of the mobility of my neck. I have some idea what you are dealing with. My Rheumatologist says the neck likely isn't related to the AS. Im not so sure. I only have one conclusive fusion of the SI joint from 2005 but suffer a lot of oddities which all could pint to the A.S. If you'd like to communicate, send me your FB page or email and we might be able to share helpful info.

[@lklovsky]

how big is risk of osteolysis with this procedure?

[@ArmaghaniSpine]

That's a very good question, Leon, and one that we are learning a lot about recently. What we have found is that within the first 6 months of this procedure, many patients may have osteolysis but do not get the main worry we have with the procedure and that is bone collapse around the disk replacement. We also know that after a year or 2 the osteolysis resolves and returns to its original density. This is why we take frequent x-rays and follow our patients closely to keep checking on if there is any collapse.

[@rosannapaluski2184]

@@ArmaghaniSpine So The only difference from the ACDF procedure to this one is the fusion? My surgeon is recommending the AC DF procedure however I continue to hear that fusions are the worst thing to get in your spine but that’s just hearsay.

[@Janeintheok]

@@rosannapaluski2184 I had this surgery 20 years ago. I have no problems with the fusion. So glad I had the surgery. Hope you're doing well.

[@cyndimiller3569]

@@rosannapaluski2184 Yes. Fusions cause bone spurs and damage to adjacent vertebrae segments. My previous fusion of C6/C7 caused bone spurs and misalignment to C4/C5, therefore causing cervical stenosis, a narrowing of the spinal cord. I have electrical surges down my arms and legs, neurological issues, vertigo, and nerve issues, such as I can't feel my stomach, so I rarely eat. Thid has ruined my life and surgery is the option after exhausted attempts. But who knows what permanent damage will remain. I had a second opinion and I only wish I found a Dr like this one who could do disc replacement.