Cervical disc herniation is most common pathology in which a cervical prosthesis is implanted.

It can also be used in cervical discs in initial stages of joint degeneration, in which the cervical nerves can be compressed by degenerative bone excrescences (osteophytes) that cause narrowing and compression of the nerve exit through the foramen.

Bryan's cervical prosthesis was the first to be implanted in 2001. After evaluating its effectiveness in 54 patients from European hospitals, it emerged as Alternative treatment to cervical arthrodesis in herniated disc surgeries.

Since then, studies have been carried out in the short, medium and long term, and no complications of interest were found in relation to dislocation of the prosthesis, loosening, infections or other complications. Unlike knee or hip prostheses, no reinterventions are required to replace the prosthesis. This is because its components do not suffer significant wear, as they do not have to withstand large loads or friction between the materials.

A cervical prosthesis operation, for example for a cervical disc herniation, lasts around 75 minutes, in which general anesthesia is used and requires extensive experience in the surgeons who perform it.

Regarding surgery, it is performed through an anterolateral approach to the neck with an incision in the skin fold of about 3cm. The tissues located anterior to the sternocleidomastoid muscle are dissected and separated, reaching directly the anterior edge of the vertebral column. This is a very common and frequent approach in which complications do not usually arise.

Subsequently, a separator is placed, the intervertebral disc is removed (discectomy), and the posterior herniated disc is removed. This is the fundamental step of surgery and requires extensive experience. Thanks to the use of magnifying glasses with a light source or microscope we ensure complete release, removing the entire hernia and any possible bone excrescences (osteophytes) that could compress the nerve or spinal cord. After extensive washing with physiological saline The cervical prosthesis is implanted through radiological control. Finally, a suction round is placed and the approach is closed in the different planes.

The cervical prosthesis or cervical arthroplasty is the currently best option for the treatment of cervical disc herniation, since the herniated fragment is extracted, the affected nerve root or spinal cord is decompressed and the intervertebral disc is replaced by a device that performs the same functions as it, maintaining the mobility of that segment as in natural vertebrae and the harmony of movement. overall neck.

Traditionally, when there was a myelopathy or radiculopathy compression due to a cervical disc herniation, the surgical treatment used was cervical arthrodesis.

This technique involves the loss of mobility of the arthrodesis level(s), producing a decrease in the harmony of neck movement. Greater mobility is transferred to the levels immediately adjacent to the arthrodesed joint, so it is not uncommon that in a few years they can also be affected by ruptures of the annulus fibrosus due to hypermobility and cause herniated discs or osteoarthritic degeneration.

Likewise, the arthrodesis postoperative period usually requires several days of hospitalization, unlike the mobile cervical prosthesis that allows the patient to go home 24 hours after the intervention. If a bone graft is used between the vertebrae, this leads to pain in the area and the risk of complications with the wound or the nerves that run nearby. A collar is used for about 8 weeks and alterations such as dysphagia (pain when swallowing) in relation to the friction of the plate with the esophagus are not rare.

Another complication that can occur is pseudarthrosis or lack of fusion of the vertebral bodies and the bone graft or implant applied, causing pain and requiring another surgery to achieve intervertebral fusion.

If there is any suspicion of a hernia or cervical pathology that may be compressing a nerve or the spinal cord, we must perform a study with the following complementary tests:

• Bone scan lateral, anteroposterior and functional in maximum extension and flexion of the cervical spine.
• Magnetic resonance (MRI).
• Neurophysiological study with electromyoneurogram.

The patient must have maintained the Symptoms derived from cervical disc herniation compression (myelopathy or radiculopathy) without significant relief with anti-inflammatories, analgesics or antineuritic drugs.

Sometimes, the pain is not bearable and it becomes necessary to perform cervical prosthesis surgery sooner.

Two or three days before surgery it is advisable not to take anti-inflammatories and only maintain treatment with analgesics to avoid the antiplatelet effect. It is not essential, but we achieve less bleeding during surgery and, therefore, less coagulation of the bleeding points.

Upon discharge from the hospital, a medical report is prepared specifying the technique and implanted mobile cervical prosthesis.

In relation to post-surgical medication, an analgesic drug is usually sufficient. Likewise, anti-inflammatory and analgesic can be complemented in the report. Muscle relaxants are only recommended in case of cervical contracture.

The surgical wound is about 3 cm on the lateral part of the neck and on one of the cervical skin folds. Only some adhesive stitches are stuck on the wound to avoid putting tension on the edges of the wound and maintaining a linear scar. It is not common for there to be complications of infection or openings of the wound due to its anatomical situation and the great vascularization of the area.

After the first 15 days you can increase cervical physical activity, although it is advisable to perform neck movements from the first moment: flexion-extension, lateralization and rotations. Avoid bad posture or handling heavy loads in the first month.

If there is any cervical discomfort due to neck contracture, in relation to the surgical posture, local heat can be applied for 20 minutes 3-4 times a day and progressive stretching exercises can be performed to avoid contractures.

If residual neck pain persists, the exercises can be complemented with a physical rehabilitation session in a specialized center.

Driving the car can be done as long as there are no limitations in cervical mobility.

During the night's rest, it is not necessary to add any special measures and the patient can maintain the posture and pillow they have been using normally.

Recovery after a cervical surgery in which a cervical prosthesis has been implanted is very fast. Only one night of hospitalization is required to maintain a drainage until the next day to evacuate small bleeding caused by the cervical hernia operation.

The patient begins the immediate neck mobility, without restrictions or significant pain. A collar is not required and daily activities can begin progressively from the first day.

If there was pain in the arm or leg before surgery, it is common to have some isolated cramp-like discomfort that will ease in the first days after surgery. Sensory alterations such as tingling (paresthesia) or swelling (hypoesthesia) sometimes last a few weeks and gradually disappear. This depends on time and intensity of compression that the nerve or spinal cord has had before surgery.

The improvement in all scales of health, comfort and well-being is evidence of the mobile cervical prosthesis. The long-term results studied do not require long-term revisions or new surgeries due to complications.

Some cervical prostheses can create anterior or posterior ossifications that limit their mobility over time. If this happens, it does not imply any clinical or functional alteration, so the Cervical prostheses do not present sequelae.

Our team traumatologists specializing in cervical prosthesis and cervical pain in Madrid is a pioneer in this series of operations, being led by Prof. Dr. Elgeadi.