|
Winter 2008 (return to main News page)
Front Range Center Neurosurgeons Featured in Style Magazine
Cervical Disc Replacement at North Colorado Medical Center
by Corey Radman, Style Magazine
There is neck pain, and then there is chronic neck pain. The first might have you popping a couple of Advil or begging neck rubs from loved ones; the latter has you at your wit’s end, seeking something, anything (perhaps explosive in nature) to relieve the throbbing.
According to the journal Spine, approximately five percent of adults will be significantly disabled by neck pain in a given year. Further studies showed that after age 40, almost 60 percent of the population shows some radiographic evidence of cervical spine degeneration. By age 65, 95 percent of men and 70 percent of women will have some sort of degenerative change on x-ray. While most people have little or no pain related to the degeneration, some must seek medical intervention.
Gerald Bradley understands living with pain. A cervical disc in his neck ruptured and he lived and worked with it for four months. “I just woke up one morning, felt like my left arm was asleep, and it never woke up again.” He couldn’t attribute the ache to anything specific. “There was no trauma. I never had a neck injury or broken collar bone. It just started hurting.”
That pain prohibited Bradley from working his business to the fullest. He owns a landscaping and hardscape company, All-Pro Lawns and Hardscapes, LLC, where he depends on his strength and mobility.
He says he was taking pain medication, “as needed instead of as directed,” and was so weary of the simplest things being so hard - like having to turn his whole body around to answer a question. He missed everyday things, “I wanted to be able to reach down and swing up my boys or pick up my 60 lb girl.” Picking them up had become excruciatingly painful and no fun for anyone.
The long-term pain made him irritable and impatient. He says, “When you’re in pain, nobody really understands. They’d ask, ‘Is there anything I can do for you?’ and I would just snap, ‘Not unless you’re a back surgeon – no!’” At 36 years old, Bradley could see that it would be a long road if he didn’t do something.
Then, a sharp increase in the pain on his left side sent him to the ER one night with thoughts of a heart attack. The ER doctor and his family doctor led him to Front Range Center for Brain and Spine Surgery (FRBS) where an MRI confirmed that Bradley had a ruptured cervical disc. Hans Coester, MD, the treating neurosurgeon at FRBS, suggested a few options for treatment, but recommended that the best choice for full recovery was a new procedure called Cervical Disc Replacement.
In essence, they would remove the ruptured or misshapen disc, thereby relieving the pressure on the nerves, which were the source of Bradley’s numbness and pain. Once the impinging disc was gone, the surgeon would insert a prosthetic disc made from chromalloy stainless steel.
Currently the only FDA approved disc is manufactured by Medtronic and is marketed as the PRESTIGE® Cervical Disc. Its ball-and-trough design duplicates the natural alignment of the neck.
Coester explains in laymen’s terms, “We make a two inch incision on the front of his neck. Then we gently mobilize all soft tissues away from the anterior spine, remove disc and bone spurs impinging on nerves, and decompress the spinal canal.”
Neurosurgeon John Viola, MD, one of Coester’s partners at FRBS, continues the explanation. “We remove the disc with small instruments to bite away residual tissue – it’s really like sterile carpentry. Then we place the disc, implanting it with x-ray guidance. We finish with fixation screws that screw into the vertebral bodies above and below the new disc.”
Coester adds that the engineers say the screws are biomechanically unnecessary, meaning that the prosthetic disc would actually remain in place and move properly without the screws. It appears to be an excellent replacement for a human cervical disc.
In previous years, the standard of care was to remove a bad disc and fuse the two adjoining vertebrae together in a procedure called Anterior Cervical Discectomy and Fusion. Using a metal plate and screws, the vertebrae were butted against each other, where they would eventually grow together. This created stability and relieved the pressure on the spinal nerves. However, fusions come with a few risks that include limited motion and especially additional stress on the adjacent cervical joints, which can cause more ruptured disks in the neck. One-third of patients with fusions will require additional surgery within ten years, according to Coester.
This is what happened to Richard Wiest, who had his first spinal fusion in 1996, and his second in 2000, performed by Viola. His third (and final, he thinks) neck surgery was just weeks ago. This time around, he had Dr. Viola do a disc replacement.
Wiest says, “It went well – I could immediately feel a difference in the pain.” His recent surgery was precipitated by severe migraines, which, so far, have not recurred.
Both patients interviewed for this story recounted their amazement at being able to move more naturally almost immediately after surgery. Bradley was happy to regain feeling in his hand the same day and he was discharged one day after surgery. Interviewed for this story nine days after surgery, he was shoveling snow. (Shhhhh… don’t tell his doctors.)
Viola notes, “The FDA has shown that fusions have been the gold standard for years. This (Cervical Disc Replacement) has better patient outcomes, less post-operative pain, and seemed even a little bit better. For a lot of cases this will replace Anterior Cervical Discectomy and Fusion.” Some patients with spine stability problems like osteoporosis will not be candidates, but “for patients with normal spinal alignment this will become the standard of care.”
The neurosurgeons from FRBS count the benefits of disc replacement. “The device is essentially stable when you put it in. Before, patients had to wear a brace for up to 6-12 weeks.” According to the PRESTIGE study, patients return to work 26 percent faster than fusion patients. Viola reports that the lower levels of post-operative pain seem to be due to the smaller opening made between patients’ vertebrae as he prepares the spines to receive the discs.
Disc problems in your neck are often diagnosed as Degenerative Disc Disease (DDD). Symptoms include: numbness or tingling radiating down the arm continuing into the hand, weakness in the upper arm (deltoid or bicep muscle), or weakness in the hand grip.
Most of the time disc disease can be controlled non-surgically through medication and physical therapy. However, it’s a comfort to know that should the need arise, Northern Colorado has gifted neurosurgeons who have had multiple successful disc replacement surgeries at North Colorado Medical Center (NCMC) and other area hospitals. Patient Wiest (who is a respiratory therapist at NCMC) reports, “The staff and surgical experience at NCMC was outstanding. They were on top of it all the way through.”
Wiest is now enjoying taking his dog, Sophie, for long walks and planning summer hiking in Rocky Mountain National Park with his family. Bradley, as noted, is already back to work and counting the days until he can pick his kiddos up and toss them in the air.
And that is exactly what their neurosurgeons from Front Range Center for Brain and Spine Surgery would want for them. Viola adds, “We try to provide the same comprehensive care of the spine that we would make available to our own families. It’s the way we would want to be treated.”
|
