Disc Replacement Arthroplasty Surgery

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Dr Keith Goh

What Is Cervical Disc Replacement?

Cervical disc replacement is a surgical procedure aimed at addressing spinal issues in the neck (cervical spine). This surgery involves removing a damaged or degenerated cervical disc and replacing it with an artificial disc device. The cervical spine, consisting of the uppermost seven vertebrae in the spinal column, is crucial for supporting the head and allowing a wide range of movements.

Traditional treatment options have typically involved cervical fusion surgery, where the affected disc is removed, and the adjacent vertebrae are fused. However, disc replacement offers an alternative that aims to preserve motion in the cervical spine.


Indications for Cervical Disc Replacement Surgery

Cervical disc replacement surgery is considered for individuals who have significant cervical disc disease. The primary indications for this surgical intervention include:

  • Degenerative Disc Disease: This condition occurs when one or more discs between the vertebrae of the cervical spine deteriorate or break down, leading to pain, weakness, or numbness.
  • Herniated Disc: A herniated disc in the neck region can cause compression of the spinal cord or nerve roots, leading to symptoms like arm pain, numbness, or weakness.
  • Cervical Radiculopathy or Myelopathy: These conditions are caused by pressure on the spinal cord (myelopathy) or nerve roots (radiculopathy) in the cervical region, leading to neurological symptoms.

Surgical Procedure

The process involves several key steps:

  1. Anaesthesia: Before the surgery, anaesthesia is administered to the patient.
  2. Positioning and Incision: The patient is placed in a supine position (lying on the back). A small incision is typically made at the front of the neck to access the cervical spine.
  3. Removal of Damaged Disc: The damaged cervical disc is carefully removed. This step is crucial for relieving pressure on the nerves and spinal cord.
  4. Insertion of Artificial Disc: A specialized artificial disc is then inserted into the space where the damaged disc was removed. The type of artificial disc used varies depending on the individual case and the surgeon’s preference.
  5. Closure of Incision: Once the artificial disc is securely in place, the incision is closed with sutures or surgical staples.

Types of Artificial Discs Used in Surgery

Artificial discs used in cervical disc replacement surgery are designed to mimic the form and function of a natural disc. Consult your neurosurgeon to inform your decision on the artificial disc that is most suited for your pain relief, restoration of function, and long-term durability.

  • Metal-on-Metal Discs: These discs are made entirely of metal, typically a combination of cobalt, chromium, and molybdenum. They are designed for durability and to provide a high degree of motion. Although strong, metal-on-metal discs may elicit metal sensitivity in some patients.
  • Metal-on-Polymer Discs: These consist of a metal endplate and a core made of medical-grade plastic, such as polyethylene. The metal component usually interfaces with the vertebrae, while the polymer provides a cushioning effect. Metal-on-polymer discs provide a good balance of flexibility and support but may wear down more quickly than all-metal discs.
  • Elastomeric Discs: Made from flexible materials, these discs aim to closely replicate the natural movement of a healthy disc. They typically have a softer core, surrounded by a more rigid outer layer. Elastomeric discs offer excellent flexibility and motion preservation but may not be as durable as metal-based discs.
  • Composite Discs: These are a combination of different materials, such as ceramic and polymer, offering both strength and flexibility.

Postoperative Care and Recovery

Postoperative care and recovery following cervical disc replacement surgery are critical for optimal outcomes. This phase focuses on healing, regaining strength, and returning to normal activities. Key aspects include:

  • Immediate Postoperative Care - Initially, patients are closely monitored in a recovery room. Vital signs, neurological status, and pain levels are assessed. Pain management, typically with medications, is an essential component of immediate care.
  • Imaging Studies - Postoperative imaging studies, such as X-rays, may be performed to confirm the correct placement of the artificial disc.
  • Hospitalisation - The length of hospital stay varies but is generally short, often 2-3 days. During this time, patients receive assistance with mobility and are educated about postoperative restrictions.
  • Rehabilitation and Physical Therapy - Rehabilitation starts soon after surgery. Physical therapy plays a vital role in recovery, helping patients regain strength, flexibility, and range of motion. Exercises are tailored to individual needs and progress gradually.
  • Home Care and Activity Modification - Upon discharge, patients receive instructions on wound care, activity limitations, and signs of complications to monitor. Patients are advised to avoid strenuous activities and heavy lifting during the initial recovery period.
  • Follow-up Appointments - Regular follow-up visits with the surgeon are crucial. These appointments allow for monitoring of the surgical site, assessment of neurological function, and evaluation of the healing process.
  • Long-term Care - Continued physiotherapy and exercises at home are important for maintaining neck strength and mobility. Periodic medical check-ups are recommended to assess the long-term performance of the artificial disc.

Potential Risks and Complications

Cervical disc replacement surgery, like all surgical procedures, carries certain risks and potential complications, which may include:

  • Nerve Damage: There is a risk of nerve damage or nerve swelling during the surgery, which can lead to numbness, tingling, weakness, or loss of function in the arms or legs.
  • Haemorrhage: Rarely, there can be postoperative bleeding into the operation site. The haematoma, if large, will need to be evacuated surgically.
  • Post-op Implant Issues: Problems with the artificial disc itself, such as infection, dislocation, wear, or failure, can occur. In rare cases, this may necessitate additional surgery to correct or replace the implant.
  • Adjacent Segment Disease (ASD): This condition occurs when the vertebral segments next to the replaced disc degenerate, potentially leading to further spinal issues requiring additional treatment.
  • Difficulty Swallowing or Speaking: Some patients may experience temporary or, rarely, permanent difficulty swallowing or changes in their voice due to the surgery’s proximity to the vagus nerve, vocal cords and oesophagus.
  • Persistent Pain: Not all patients achieve complete relief from pain; some may continue to experience neck or nerve-related pain or develop new pain after surgery.
  • Spinal Cord Injury: Although very rare, there is a risk of spinal cord injury during the surgery, which could lead to significant disability.
  • Vertebral Fracture: Manipulation of the spine during surgery can very rarely lead to fractures in the vertebrae, requiring additional treatment.

Advantages of Cervical Disc Replacement

Cervical disc replacement surgery offers several advantages over traditional spinal fusion surgery, contributing to its growing popularity as the leading treatment option for certain types of neck pain and spinal conditions.

  • Preservation of Neck Mobility: Unlike spinal fusion, which immobilizes a portion of the spine, cervical disc replacement maintains the natural movement of the neck. This is due to the artificial disc’s ability to mimic the movement of a healthy, natural disc.
  • Reduced Stress on Adjacent Discs: By preserving natural neck movements, cervical disc replacement reduces the stress transferred to adjacent vertebral segments. This can potentially lower the risk of degeneration in these adjacent segments, a common complication in spinal fusion.
  • Faster Recovery: Patients often experience a quicker recovery period with cervical disc replacement compared to fusion surgery. This can lead to a shorter hospital stay and a more rapid return to normal activities and work.
  • Lower Reoperation Rates: Studies have shown that the rate of reoperation is generally lower with cervical disc replacement compared to fusion, indicating its effectiveness and long-term durability.
  • Improved Quality of Life: Many patients report significant improvements in their quality of life following cervical disc replacement, with reduced pain and enhanced ability to perform daily activities.

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Dr. Keith Goh






With more than 20 years of experience in the field of Neurosurgery, Dr Keith Goh’s subspecialty includes treatment of brain and spinal cord tumours and pediatric neurosurgery.

He is the Medical Director of International Neuro Associates, which is based at Mount Elizabeth Medical Centre, and provides specialist neurological services to all the hospitals within the Parkway Pantai hospital group. He also was Honorary Associate Professor of Neurosurgery at the Prince of Wales Hospital of the Chinese University of Hong Kong.

  • Bachelor of Medicine & Surgery — National University of Singapore
  • Neurosurgical Residency at the Chinese University of Hong Kong
  • Advanced specialty training in paediatric neurosurgery at the Beth Israel Institute of Neurology & Neurosurgery in New York

His bibliography includes 40 original articles, 11 book chapters, and 104 abstracts and lectures on his various research interests, such as brain tumours, spinal cord tumours, head trauma, conjoined twins and congenital malformations in children.


Mount Elizabeth Medical Centre,
#09-10, 3 Mount Elizabeth
Singapore 228510

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    Frequently Asked Questions (FAQ)

    How long is the recovery period?

    Most individuals start to feel better within 1-2 weeks and return to normal activities within a month. Complete recovery and the full benefits of surgery may take longer. Consult your neurosurgeon to obtain further details about your expected recovery timeline.

    How much pain can I expect after cervical disc replacement surgery?

    Most patients experience mild to moderate discomfort, which can be controlled with prescribed pain medication. The intensity of pain typically decreases significantly within the first two weeks after surgery. Nerve-related pain might take longer.

    What are the chances of the artificial disc moving out of place?

    The risk of an artificial disc moving out of place, also known as disc displacement, is relatively low. Modern surgical techniques and the design of the implants minimize this risk. Following the surgeon’s postoperative instructions is crucial to avoid activities that could lead to displacement, such as lifting heavy weights.

    Is there a risk of allergic reactions to the artificial disc material?

    Allergic reactions to the materials used in artificial discs are extremely rare. These implants are typically made from biocompatible materials that minimize the risk of adverse reactions. However, if you have known allergies to certain metals or materials, inform your neurosurgeon before the surgery.