The cervical prosthesis is a common treatment for a pathology of the cervical spine. By replacing the injured structure with medical equipment, it aims to free the compressed structures: a nerve or part of the spinal cord. How is the placement of a cervical prosthesis carried out? ? Is it effective? When is it indicated? What are the risks and complications of this surgery? The answers in this article.
Definition of a cervical prosthesis
La cervical prosthesis is a surgery to replace a damaged disc located between two cervical vertebrae. This is an alternative to arthrodesis techniques.
Note: To find out everything about cervical arthrodesis, see the following article.
The spine brings together several elements, the main ones being the vertebrae, intervertebral discs (between the vertebrae) and the elements of the nervous system (central and peripheral).
Over time, the intervertebral discs wear out and cause compression on the structures located inside the spine. This is also responsible for the appearance of certain diseases such as cervical disc herniation. The damaged disc irritates the spinal cord and the nerves which lie in the vicinity. These situations cause unpleasant symptoms such as loss of sensation, pain or muscle weakness.
La placement of the cervical prosthesis involves removing the damaged cervical disc and replacing it. The goal is to relieve pressure on the spinal cord and nerve roots. The painful symptoms will then subside.
Results may vary from patient to patient, but in the majority of cases the cervical prosthesis shows evidence of effectiveness.
Indications and contraindications of this surgical technique
La cervical prosthesis is generally indicated in adults with degenerative disc disease of the cervical spine. It is used to treat the herniated disc especially when the pathology no longer responds to traditional or conservative medical treatment.
Doctors also recommend it for:
- people who have a cervical disc osteoarthritis painful resistant to drug treatments;
- people who suffer from neck or arm pain associated with neurological symptoms such as cervico brachial neuralgia, loss of root muscle strength, sensory deficit, tingling along the arm...
Most often, cervical osteoarthritis and herniated disc concern the C5-C6 and C6-C7 floors. Insofar as the pathology appears at the level of the two floors, a simultaneous intervention can be done on the two damaged discs.
On the other hand, the cervical prosthesis also has some contraindications. These are the following cases:
- unstable cervical spine injury (regardless of cause);
- osteoporosis, Paget's disease, osteomalacia or other metabolic bone disease;
- regular use of corticosteroids (source of bone fragility);
- active tumor pathology;
- known allergy to metal components…
The procedure to follow for the intervention
The intervention is systematically preceded by a consultation of the patient. The surgeon will examine you and consult your medical file, in particular the results of your additional examinations (imagings). If the indication for cervical prosthesis surgery is confirmed, he will explain the advantages and risks of this intervention.
For the procedure, the patient is put under general anesthesia. The operation lasts about 45 minutes to 2 hours. The surgery involves 4 steps: the incision, the discectomy, implant and closure.
During the incision, the surgeon makes an approach on a fold of the neck, more precisely on one side of the trachea. The incision is only 30 to 40 millimeters.
He then makes a discectomy. This step consists of remove the worn intervertebral disc. The blood vessels will be cut in order to be able to reach the pathological disc. To control the level, monitoring by radioscopy will be essential. Discectomy requires the use of special forceps to remove visible disc material. They also make it possible to remove the herniated disc or the growths compressing the naves and the spinal cord, if this is the case.
Once the disc space is freed, the surgeon implants a phantom of the cervical disc prosthesis while closely observing the opening and position of the disc space. Only afterwards will he install the definitive prosthesis between the two vertebrae.
To complete the operation, the disc space is filled with a device to maintain intervertebral mobility. The wound is then closed with an absorbable suture and a drain to avoid postoperative hematoma.
Recovery and rehabilitation after placement of a cervical prosthesis
During the recovery period, you must stay in the hospital for 24-72 hours. During your stay, you will be given painkillers to relieve the pain. You can return home after a few days with the help of a driver.
Until healing is complete, the dressing should be done daily by a nurse. Wearing a neck brace is sometimes recommended for a period to avoid mobilization of the neck.
For rehabilitation, it is advisable to use physiotherapy (physiotherapy). It allows you to retrain the muscles and maintain the mobility of the vertebrae in a progressive and safe manner. Rehabilitation will begin under the supervision of a physiotherapist. He will then suggest some exercises that only you can do at home.
Normally, the surgeon informs on the adequate postures as well as the duration of the rest during the period of convalescence. They will have to be respected to avoid a relapse.
The resumption of professional activity is possible if it is a sedentary job without significant physical demands (such as in an office or in front of the computer). With regard to sports activities, they can be resumed gradually provided that the patient is assisted by a health professional who will guide him through the stages of recovery.
In the event of significant physical constraints, convalescence can last up to 3 months. The control of the evolution of the intervention is carried out at 4 weeks after the operation, then at 3-6 months and at 1 year.
What are the risks and complications?
Immediately after the operation, lifting is authorized as well as the swallowing of liquids and solid foods. Here are the risks and complications of a cervical prosthesis:
- a risk of phlebitis (inflammation of the vein);
- hematoma ;
- bleeding;
- surgical site infection...
In exceptional cases, certain more specific complications, such as recurrent nerve damage, can be observed. Neurological complications are rare in this type of intervention. The pain may persist, but not necessarily.
If you have a myelopathy (disorder of the spinal cord), the risk of neurological complication and lesion of phlebitis can go up to 3% if normally it is lower than 1%.
There is also a risk of complete and permanent paralysis even if it is encountered quite rarely.
In the case of a complex procedure, the superior laryngeal nerve (nerve of the vocal cords) can be stretched. This is likely to cause a sometimes definitive bitonal voice.
A compressive hematoma of the neck can also cause unpleasant discomfort when swallowing or even breathing.
There may also be a lesion of the nerve net which can cause Claude Bernard syndrome. The latter results in a drop of the eyelid, a smaller eye and a pupil more closed than the other.
What must be remembered is that before opting for a cervical prosthesis, it will be necessary to ensure that the benefits outweigh the risks. Seek the advice of various specialists to help you make the best possible choice. Postoperative imaging checks are essential to monitor the outcome of the operation. This can be a CT scan, an MRI or a scintigraphy.
References
My name is Arotoky and I am studying human medicine. Web editor for more than 5 years, I currently focus on the theme of health and well-being. I have the strong conviction that with my valuable articles, I can help many people to relieve their ailments and feel better. My goal is to share my health knowledge with the general public through web writing.