Dr. Kern Singh, orthopedic surgeon at Midwest Orthopedics at Rush, talks about relieving pain with a cervical disk replacement.
Interview conducted by Ivanhoe Broadcast News in 2023.
What and where are the cervical disks?
Singh: Cervical disk basically begins at the back of your skull and then essentially to the top of your shoulders. In that, there are seven vertebral levels, C1 through C7, and each one of them has a disc.
It’s basically the neck?
Singh: Yes.
Does a lot of wear and tear go through this area?
Singh: Most people actually don’t have much wear and tear in the neck. For some reason, some people may be genetically predisposed. Some people have risk factors like smoking. Some people can have traumatic injuries. But for the most part, our cervical discs actually wear very well over time.
What can happen to cervical disc. Why do people come to you for cervical disk issues?
Singh: Most times people come to me not for neck pain but for arm pain that occurs as a result of the wearing out of the disk in the neck. People manage neck pain pretty well. Anti-inflammatory, stretching, physical therapy. But it’s the arm pain, the weakness when the disk wears out or causes pressure on the nerve root, that really causes a patient to seek help.
What are the most common demographics of people who have cervical disk issues?
Singh: It’s probably two is bimodal. Those who are younger, who are active in their 20s and 30s, have a traumatic injury, maybe playing sports to slip and fall, and they get a jelly-like substance that pushes out from the disk and causes irritation on the nerve root. We call that a herniated disk. Then there’s a little bit of the older population, those in their 50s-70s where the disk wears out and bone spurs form. Those bone spurs cause pressure on the nerve roots causing arm and neck pain.
Are you saying the most common symptom of a cervical disk problem is generally at an upper extremity?
Singh: That’s right. People think that we’re neck and back surgeons, but we’re actually arm and leg surgeons. People get arm pain or leg pain due to the problems in their spine.
Interesting. What is life like living with arm or neck pain? Do you have patients that come to you and say “Life is difficult for me.” Why is this?
Singh: Most people say that life is miserable because if you imagine if you have neck problems then the worst position for a patient is for them to extend their neck so when they look back or look up. So you do that when you have to sleep. It affects sleeping. Then lack of sleep leads to irritability, anxiety, depression, all of these factors and affect their quality of life, their work, affects their activities that they enjoy doing what they have to do. Most people say that it has a traumatic or dramatic effect on their quality of life.
What’s the traditional treatment? What traditionally has been done? What are you doing now?
Singh: The mainstay of treatment for most people who have neck symptoms and arm symptoms is physical therapy and anti-inflammatory. Ninety-five percent of people get better. Thereafter, for those five percent who need something done, injections can be helpful. The problem with injections is if it’s a mechanical pressure on a nerve root, that injection doesn’t necessarily alleviate that pressure. Those who fail that the traditional treatment involves putting a plate and screws inside the patient’s neck, so fusing it. In fact, I just saw a patient who was told that broke down, and started crying because fearful of having an immobile neck. That’s been traditionally in which still the vast majority of surgeons offer patients at this point. It works very well, the problem is that it creates a domino effect. Someone gets their neck fused or one or two levels that then puts pressure potentially on the adjacent level, the level above or the level below. Then it’s trying to chase dominos, so to speak. Pretty soon the patient is unable to move their neck. Over the last couple of years, disc replacements have become more popular. They have been approved by the FDA for a long time, over a decade. The challenge with the disc replacement is it’s surgically a harder procedure to perform. Technically, it’s a little bit more demanding. It hasn’t taken off necessarily as mainstream.
But you’re doing it?
Singh: Yes. For about 10 years or so.
Show us what that is and explain what that is.
Kern Singh: Here we’re looking at the front of a patient’s spine. This would be the bone and then inside would be the disk, and this is the device where we replace the disk and this is the bone below. We’ll call this C5 and this we’ll call that C6. This is the actual disk replacement device that we or myself I implant in patients, and you can see it’s less than the size of your fingertip. It looks very similar to a hip and knee replacement. In fact, if I open this up, you can see that there is a titanium end plate, which means that goes against the bone. There’s a plastic, another piece of titanium. The bone grows into the titanium and the plastic basically acts like a shock absorber the disk allows the spine to physically move forward and then back, side-to-side, and then rotation. If we look at it from the side, this allows this patient here with a disk replacement to keep on moving their neck. As opposed to the fusion where we would take out this disk, put a spacer in, and a plate and screws across there, which would fix this segment. This allows a patient to maintain more natural motion.
If you had to summarize the benefits of this here, how would you summarize that?
Singh: I would say it’s the exact same procedure as a cervical fusion but the main benefit is you get to maintain your motion. That means you get to do all the simple things that people take for granted, like driving a car, looking over your shoulder, looking down at your phone. The other advantage of the disk replacement is because it’s moving it protects the level above and below from wear and tear. You’re not transferring one problem to the next level. The last benefit of a disk replacement is that we know that disk replacements have significantly long lifespans, meaning we now have data over 20 years with disk replacements and they have not had to be revised. Longevity is also an advantage.
How long does it take?
Singh: The procedure itself? In our hands, it takes about 25 or 30 minutes per level. We do this or I do this as an outpatient. This means patients go home from the surgery center about six hours or so after surgery.
Who is a good candidate? Clayton obviously was. Why was he a good candidate for this?
Singh: Clayton had a large disk herniation, and he had triceps weakness. He has a very strenuous job. His option was either a fusion or live with it, with his weakness, he’s unable to do that. Good candidates are patients who have primarily arm symptoms, and weakness in their arm, and they can have neck symptoms as well. When the next symptoms are outshined by the arm symptoms, those are people who do very well and then patients who have problems at one or two levels since the FDA has only approved a two-level disk replacement.
You just told me about Clayton. You told me why he was a good candidate and you told me about his alternatives. How is Clayton?
Singh: He feels great. His triceps strength is back to normal. He’s been very active, probably more active than I allowed him to be. The patients don’t tell me how inactive they are, but his X-rays look great as far as the alignment’s concerned. He has no arm pain and his neck pain is significantly improved.
Does he have any limitations?
Singh: Only just because it’s not fully healed yet. I haven’t let him go into any contact sports. Snowboarding, skiing. I did wear a UFC fighter that went back to playing or wrestling in the UFC or fighting the UFC.
Will he need another replacement at any time?
Singh: Not unless he has a problem with a separate level, but nothing from this device once it’s healed. We have data from 20 years at the disk replacement and keeps on working.
Anything that you would like to add, to Clayton particularly why you’re the person to come to do this, or what your relationship is with this treatment, and with this procedure?
Singh: I think that the biggest thing that I tell patients is that if any physician or surgeon tells you you need a fusion you should seek an alternative. Almost every single person is a candidate for a disk replacement. It just depends upon the experience and the comfort level of the surgeon with the disk replacement. There’s no reason for a degenerative condition where a patient needs to have a fusion at this point, a disk replacement, I believe will become the standard of care.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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