Dean Bird - cervical disc replacement for a prolapsed disc in the neck
Dean Bird, a 43 year old IT Manager from Chafford Hundred in Essex, had private cervical (neck) disc replacement surgery at Spire Hartswood Hospital in Brentwood in March 2012. Dean has kindly agreed to share his treatment story….
“Since 2005 I have suffered from severe spondylitis in my neck. It all started when one of the discs in my neck prolapsed into my spinal cord, causing tremendous pain down my left arm. My consultant diagnosed a cervical disc prolapse and recommended cervical fusion surgery at Spire Hartswood (then Bupa Hartswood) Hospital. The treatment relieved my pain and I recovered well although, as predicted, my neck movement was restricted.
In February 2012, I had similar symptoms down my right arm and I was pretty sure the same had happened again. After seeing Consultant Neurosurgeon, Mr Raghu Vindlacheruvu, and having an MRI scan it was confirmed that the disc next to my earlier fused disc had also prolapsed. Mr Vindlacheruvu explained that he could offer a new technique to replace the disc with an artificial one rather than performing a disc fusion. The benefit of the new operation should be that I would retain neck flexibility, unlike my first operation in 2005. I was happy with this and decided to proceed with the operation.
The pain from this condition can be, and usually is, unbearable and really restricts your day to day life. For example, the pain radiating down the arm is constant and the only relief I could get was from wrapping my left arm around the back of my neck which is not a good look! Bathing helped me a lot too and took the pain away quite a bit. I was having up to eight baths a day. Driving is very hard because turning the neck to look behind you aggravates the nerve that is being compressed.
The pain is always there and, on both occasions, I felt that an operation was the only practical choice if I wanted to be free from pain. To be honest, I was a lot less apprehensive the second time around. Even though it is a major operation, the after effects are pretty minimal and the benefits of having the disc fixed outweigh any soreness afterwards.
When I awoke from the operation the pain down my arm had gone straight away. Since my fusion surgery in 2005 my neck has been severely restricted in movement, Not this time. No further restriction was felt at all. All I felt was a little sore around the area of the incision and drowsy. I stayed in the high dependency unit for around 18 hours as a precaution (this is usual after this type of spinal surgery). I was originally booked to stay in the Spire Hartswood for three nights but it ended up being just two nights. Don’t get me wrong - I love the Spire Hartswood with its clean, caring staff and lovely food. But there’s no place like home.
I’m very lucky that my company provides Bupa private medical insurance for me. Spire Hartswood has always been my favourite hospital as they are so caring. I chose Mr Raghu Vindlacheruvu mainly because he had succeeded my original surgeon, Mr Robert Malpas, who had emigrated in 2006. I found Mr Vindlacheruvu to be very caring and he explained the process fully and in so much detail that I felt safe in his hands.
Both operations were the best thing I ever did. I feel no ill-effects from the operation and the latest cervical disc replacement operation was much better as I lost none of the flexibility in my neck.
I’d like to thank all the staff at the Spire Hartswood Hospital and, in particular, Mr Raghu Vindlacheruvu for the great care and for making the pain go away.”
The surgeon’s view –
Mr Raghu Vindlacheruvu, Consultant Neurosurgeon
Symptoms and diagnosis
Dean came to me having suffered for one month with terrible neck pain and right arm pain. He had already tried a number of strong painkillers and anti-inflammatory drugs. He had undergone a previous neck operation in 2005 for a prolapsed disc; I suspected a new large disc prolapse and an MRI scan confirmed this.
I discussed a range of options including medications licenced for nerve-related pain and nerve root steroid injections. On balance, however, I recommended surgery given the large size of the disc, the severity and duration of his pain, and the failure of medication to help. I gave Dean a written leaflet describing the condition and the aims and risks of surgery.
Cervical disc replacement surgery
Neck surgery is common and can have excellent results in my experience. Surgery aims to relieve the pressure from the spinal cord and/or nerve root. The approach is through a 3-4 cm incision in a skin crease on the front of the neck, with careful dissection between the carotid artery and the gullet. The disc is cut out and the ruptured fragment is removed to relieve pressure on the nerve/spinal cord. Some surgeons finish the operation at this point. Most would insert a ‘cage’ to restore normal alignment in the neck and to help keep the bony channel open where the nerve root exits the spine.
Dean was potentially the perfect patient for new technique of cervical disc replacement. He was young, with a short duration of symptoms due to a soft disc prolapse rather than chronic degenerative change. Artificial discs preserve motion in the operated segment, reducing and delaying the risk of degeneration at other levels in the neck. With cervical fusion (Dean’s first operation), the remaining adjacent segments have to work harder and this can accelerate degenerative change in these discs.
For Dean’s cervical disc replacement I used the Prodisc-C Nova artificial disc from DePuy Synthes. This has titanium plates with a polyethylene insert. It is crucial to fit the correct sized prosthesis in precisely the correct site to minimise the risk of fusion and to replicate normal movement. This precision is achieved with the use of X-ray guidance during the operation. The surgeon can revert to fitting a cage at any stage in the procedure if circumstances are not appropriate for an artificial disc.
Post-operative care and results
Patients are observed closely in the high dependency unit after surgery. My patients usually go home one or two days after surgery, following review by the physiotherapist. Neck pain is generally quite minimal and patients can expect to return to normal activities within six weeks.
I believe that the key to excellent results is careful patient selection and precise surgery. Dean has had a stunning outcome; he has no symptoms and an excellent range of neck movement. He was my first cervical disc replacement patient at Spire Hartswood Hospital. Further cases have followed, and the Hartswood theatre team has learned this new technique rapidly with support and training from De Puy Synthes.