UNC Health Care
From-behind perspective of man clutching back of his neck

A Surgical Solution for Degenerative Disease in the Neck

Tiny structures in your neck can create big problems elsewhere in your body. Cervical osteoarthritis, characterized by the deterioration of the bones and cartilage in the neck, can cause radiating pain in the arms and legs, numbness, difficulty walking, lack of coordination and even incontinence.

And it’s not rare—about 1 in 5 people older than 65 deal with symptoms from arthritis in the neck, says Deb Bhowmick, MD, a neurosurgeon specializing in complex spinal surgery at UNC Medical Center.

Fortunately, UNC Health Care offers a procedure to help alleviate these symptoms: total disc arthroplasty, or TDA.

How TDA Works

The discs in your neck, or cervical discs, are pads between vertebrae that keep the bones from rubbing together. When these discs degrade, they can cause radiculopathy, which is compression of a nerve in the spine, or myelopathy, which is damage to the spinal cord. These conditions typically cause radiating pain.

“Patients often say it’s a shocking arm pain that goes from the neck down to the arm,” Dr. Bhowmick says. “They usually complain of arm pain more than anything.”

Both radiculopathy and myelopathy can be treated with TDA, in which the surgeon makes a small incision and removes the damaged disc and tissues. The vertebrae are gently spread apart, and an artificial disc made of metal and plastic is inserted.

“With artificial discs, you’re decreasing the chances of developing more arthritic problems at different levels of your spine, so you’re also decreasing the chances of needing further surgery in the future,” Dr. Bhowmick says. “We’re decreasing the amount of wear and tear at the other levels of the spine.”

An older procedure for cervical disc disease, predating TDA, is called an anterior cervical discectomy and fusion (ACDF), more commonly known as a spinal fusion. During ACDF, the damaged disc is removed, and a bone graft is put in its place to stabilize the area. Over time, the body heals the graft, which fuses the bone together.

The downside with ACDF is that it causes a limited range of motion, Dr. Bhowmick says. So while it can reduce the symptoms of cervical degeneration, it also “fuses that segment of the spine, so the other segments have to work harder.”

This stress can cause further arthritic changes, called adjacent segment disease, to the different areas of the spine. This may require more surgery; a TDA procedure reduces that risk.

Going Through TDA

Artificial discs aren’t new, but in the past two years, the surgery has been approved for more parts of the spine, including the neck.

“I think the idea of being able to do the surgery at multiple spine levels allows us to tackle a larger number of diseases and help more patients,” Dr. Bhowmick says. “Before, some people might have had multiple operations on both the front and back of the spine or have more levels fused.”

When Larry Smith, now 75, was experiencing arm weakness about four years ago, he had a laminectomy, in which the back of one or more vertebrae is removed and the remaining bone is fused, and a laminoplasty, which relieves pressure on the spinal cord, to stop its progression.

“I did well for a few years, but then I began to have some increased weakness and a limited range of motion,” Smith says. He went for a follow-up with his neurologist, who referred him to Dr. Bhowmick. After reviewing Smith’s MRI results, Dr. Bhowmick recommended TDA.

“The idea was to prevent my arm from getting any weaker and maybe have some improvement,” Smith says.

In April, Smith underwent the TDA procedure with Dr. Bhowmick and has been going to physical therapy to improve his range of motion and strength. Although Dr. Bhowmick says it will be a few months before Smith sees any possible improvement to his arm weakness, Smith is finding day-to-day tasks easier than before.

“Since the surgery, I’m able to do some things that I haven’t been able to do in a couple of years,” he says. “I hadn’t been able to use my left hand to part my hair, and I’m able to do that now, and I’m not having as much trouble with buttons. It’s still a little difficult, but it’s not like it was before. I feel better, and I’ve been very pleased with the recovery. This particular surgery has really done well for me.”


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