Arthroplasty is an orthopedic surgical procedure where the articular surface of a musculoskeletal joint is replaced, remodeled, or realigned by osteotomy or some other procedure.
Loss of space between your cervical vertebrae from cervical disk degeneration, or wear and tear, is common.
Cervical disks begin to collapse and bulge with age; this happens to most people by age 60.
Cervical disk replacement surgery involves removing a diseased cervical disk and replacing it with an artificial disk.
It is done when the space between your vertebrae has become too narrow and part of your vertebrae or your cervical disk is pressing on your spinal cord or spinal nerves, causing you pain, numbness, or weakness.
Kamran Parsa, DO., is here to help answer any questions you may have if Cervical Disc Arthroplasty has been prescribed by your doctor.
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What is Cervical Disc Arthroplasty?
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Learn more about Kamran Parsa, DO
Kamran Parsa, DO
Kamran Parsa, DO., is a Neurosurgeon and a member of the Medical Staff at Palmdale Regional Medical CenterLearn more about Kamran Parsa, DO
Transcription:
Melanie Cole (Host): Neck pain can have a variety of causes – poor body mechanics herniated discs and osteoarthritis are just a few. Neck problems can affect the quality of your life and be very painful. My guest today is Dr. Kamran Parsa. He is a neurosurgeon and a member of the medical staff at Palmdale Regional Medical Center. Welcome to the show, Dr. Parsa. First, I’d like to ask you, what are some of the most common causes of neck pain that you see?
Dr. Kamran Parsa (Guest): Hi, Melanie. Thank you for having me on the show. The most common causes that I see for neck pain are degenerative changes of your cervical disc and facet joints that are in the back of your neck. That’s the most common cause of neck pain and then, that can also cause pain going down into your arms and shoulders, between your shoulder blades and also referred pain causing headaches, migraines. It can present many different ways but the most concerning are generally when you have weakness in your hands. Numbness and tingling going down your hands is when it is an important time to consider seeing a neurosurgeon.
Melanie: Because it’s the neck, give the listeners the reason – or if there is a reason – to see a neurosurgeon versus an orthopedic surgeon for neck issues.
Dr. Parsa: That’s a good question. Orthopedic surgeons are not all spine surgeons. For orthopedic surgeons to operate on the spine, they go through one year of fellowship after their five years of training as orthopedic surgeons to be able to operate on the neck. As a neurosurgeon, for the first seven years of training, from day one we are involved with all types of spine surgery. Half of the training is on the brain, half of it is on the spine. Then, there are also fellowship trained surgeons, such as myself, where I did an extra year of fellowship training to be subspecialized in complex deformity spine surgery, minimally invasive surgeries out there to be able to help my patient population better.
Melanie: The neck can get quite painful when there are problems. If somebody does, as you say, have weakness in their arms, pain radiating down, what is the first thing you do for them to determine the cause?
Dr. Parsa: The first thing to do is to get an MRI. That’s when we can assess whether there is any herniated discs or osteophyte complexes in certain areas of the spine that can push on your nerves or your spinal cord which can cause a variety of different symptoms.
Melanie: If somebody does have a herniated disc or a bulging disc, what has been the typical surgery to help cure the situation?
Dr. Parsa: Classically, it started in the ‘60’s where they would do a discectomy. For the herniated disc that was pushing on your nerve or your spinal cord, a discectomy is performed and arthrodesis of the bone and then, eventually, you’d place a graft with screws and plate. That’s called an “ACDF” or “anterior cervical discectomy fusion” which has become the gold standard treatment. However, it did have its drawbacks but that is usually what is used.
Melanie: Tell us a little bit about cervical disc arthroplasty and how that differs from this typical fusion surgery.
Dr. Parsa: The main drawback of fusion surgery is exactly that – it fuses two segments in your spine together and promotes adjacent level disease down the line requiring further surgery. In the ‘90’s and more so in the early 2000’s, researchers started to develop systems and approaches to preserve motion in your neck while addressing the main issue of the herniated disc or bulging disc. Disc arthoplasty effectively does the same thing as a fusion surgery where you do the discectomy to decompress or take the pressure off your nerve within the spinal cord but, in place of fusing the spine with a graft and screws and plate, you place a device that maintains motion at that segment so, effectively not only maintaining motion but also decreasing the pressure on the adjacent levels and decreasing the need for more surgeries down the line.
Melanie: So, the main goal is to maintain range of motion in their neck. Tell us a little bit about this artificial disc device.
Dr. Parsa: The artificial disc – there are many different companies on the market and each of them have their own advantages and disadvantages. Essentially, all of them have titanium and a screw system and a fusion device where the titanium sits against the bone and in between the titanium is, in one form or another, a polymethylmethacrylate type of plastic device that has been used for decades in joint surgery by orthopedic surgeons. It’s not any new material that can cause reactions or anything. It’s not an innovative material. It’s just using the same materials we’ve always used in a different part of the body. Depending on the device manufacturer, they use different designs to maintain the motion in the neck.
Melanie: Who is a candidate for cervical disc arthroplasty and who might not be a candidate for this?
Dr. Parsa: Good candidates are younger individuals who have preserved good endplates in their neck, good architecture where the device can sit appropriately. If there is a severely degenerated disc that the device cannot sit on properly, I don’t feel that the individuals are a good candidate for disc arthroplasty. Also, individuals who have an infection in their neck or have osteoporosis would not be a good candidates. Most important for me is individuals who have cervical facet joint disease and deformity of their necks where your neck is not aligned properly in the first place and you need to reconstruct the cervical spine or the neck. In those cases, you want to create a stiff construct such as a fusion case. Where disc arthroplasty does the exact opposite. Also, if your pain generators are from your facet joints in the back, it is the motion that creates the neck pain and a lot of the disability associated with it. By fusing segments and that facet joint, you are helping with the pain. I like to treat every patient individually. I take a look at all of these different aspects – age, co-morbidities, how the total alignment of the spine is--and put it all together and come up with the best plan. Disc arthroplasty, I think of it as a nice, new technique that can help and offer more advantages than the classical approach for, as I mentioned, certain sub-sets of patients but not everybody.
Melanie: When looking at the discs on either side of the affected disc and protecting that adjacent disc level, what do you tell patients about what they can expect for recovery?
Dr. Parsa: What’s wonderful about the disc arthroplasty is that you don’t need a cervical collar. In fact, I promote more motion and going back to work as soon as possible. In all neck surgery, I would expect some muscle spasms in the back of the neck for a few days but a lot of my patients, after their disc arthroplasty, go back to work within a week and progressively increase their activities. So, by about three months, they are back to doing whatever contact sports or whatever they would normally do.
Melanie: That’s absolutely fascinating and really amazing. In just the last few minutes, what should people with orthopedic issues of their necks be thinking about when seeking care?
Dr. Parsa: Most importantly, the neck is an important part of your body. It can cause significant disability. My red flags are always if you have numbness, tingling or weakness in your hands, do not ignore it. If you feel your balance is off, or if you have bowel or bladder incontinence, do not ignore these symptoms. These are all red flags that you have to seek care as soon as possible. Overall, if you have significant neck pain and it’s affecting your daily life, there are many good options which are even not surgical – outside of my realm of practice. Just seeking the right care to help your recovery and give the right exercises. Almost 80 - 90% of neck pain and even mild shoulder pain associated with it, all of these can resolve non-surgically but you would want to treat it and seek advice from a professional as soon as possible so that your pain can be relieved sooner.
Melanie: Why should patients come to Palmdale Regional Medical Center for their care?
Dr. Parsa: My experience with Palmdale Regional Medical Center has been outstanding this year. They’re a new facility with a very friendly staff, responsive staff. They have a very good system. They take excellent care of their patients. The patients have private rooms. That’s one of the biggest advantages that my own patients have complimented Palmdale about in the past. At least from my standpoint, they have a designated joint and spine unit where the staff there is specifically trained in taking care of spine patients and I think that is very beneficial for our patients.
Melanie: Thank you so much for being with us today. It’s great information. You’re listening to Palmdale Regional Radio. For more information you can go to PalmdaleRegional.com. That’s PalmdaleRegional.com. Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): Neck pain can have a variety of causes – poor body mechanics herniated discs and osteoarthritis are just a few. Neck problems can affect the quality of your life and be very painful. My guest today is Dr. Kamran Parsa. He is a neurosurgeon and a member of the medical staff at Palmdale Regional Medical Center. Welcome to the show, Dr. Parsa. First, I’d like to ask you, what are some of the most common causes of neck pain that you see?
Dr. Kamran Parsa (Guest): Hi, Melanie. Thank you for having me on the show. The most common causes that I see for neck pain are degenerative changes of your cervical disc and facet joints that are in the back of your neck. That’s the most common cause of neck pain and then, that can also cause pain going down into your arms and shoulders, between your shoulder blades and also referred pain causing headaches, migraines. It can present many different ways but the most concerning are generally when you have weakness in your hands. Numbness and tingling going down your hands is when it is an important time to consider seeing a neurosurgeon.
Melanie: Because it’s the neck, give the listeners the reason – or if there is a reason – to see a neurosurgeon versus an orthopedic surgeon for neck issues.
Dr. Parsa: That’s a good question. Orthopedic surgeons are not all spine surgeons. For orthopedic surgeons to operate on the spine, they go through one year of fellowship after their five years of training as orthopedic surgeons to be able to operate on the neck. As a neurosurgeon, for the first seven years of training, from day one we are involved with all types of spine surgery. Half of the training is on the brain, half of it is on the spine. Then, there are also fellowship trained surgeons, such as myself, where I did an extra year of fellowship training to be subspecialized in complex deformity spine surgery, minimally invasive surgeries out there to be able to help my patient population better.
Melanie: The neck can get quite painful when there are problems. If somebody does, as you say, have weakness in their arms, pain radiating down, what is the first thing you do for them to determine the cause?
Dr. Parsa: The first thing to do is to get an MRI. That’s when we can assess whether there is any herniated discs or osteophyte complexes in certain areas of the spine that can push on your nerves or your spinal cord which can cause a variety of different symptoms.
Melanie: If somebody does have a herniated disc or a bulging disc, what has been the typical surgery to help cure the situation?
Dr. Parsa: Classically, it started in the ‘60’s where they would do a discectomy. For the herniated disc that was pushing on your nerve or your spinal cord, a discectomy is performed and arthrodesis of the bone and then, eventually, you’d place a graft with screws and plate. That’s called an “ACDF” or “anterior cervical discectomy fusion” which has become the gold standard treatment. However, it did have its drawbacks but that is usually what is used.
Melanie: Tell us a little bit about cervical disc arthroplasty and how that differs from this typical fusion surgery.
Dr. Parsa: The main drawback of fusion surgery is exactly that – it fuses two segments in your spine together and promotes adjacent level disease down the line requiring further surgery. In the ‘90’s and more so in the early 2000’s, researchers started to develop systems and approaches to preserve motion in your neck while addressing the main issue of the herniated disc or bulging disc. Disc arthoplasty effectively does the same thing as a fusion surgery where you do the discectomy to decompress or take the pressure off your nerve within the spinal cord but, in place of fusing the spine with a graft and screws and plate, you place a device that maintains motion at that segment so, effectively not only maintaining motion but also decreasing the pressure on the adjacent levels and decreasing the need for more surgeries down the line.
Melanie: So, the main goal is to maintain range of motion in their neck. Tell us a little bit about this artificial disc device.
Dr. Parsa: The artificial disc – there are many different companies on the market and each of them have their own advantages and disadvantages. Essentially, all of them have titanium and a screw system and a fusion device where the titanium sits against the bone and in between the titanium is, in one form or another, a polymethylmethacrylate type of plastic device that has been used for decades in joint surgery by orthopedic surgeons. It’s not any new material that can cause reactions or anything. It’s not an innovative material. It’s just using the same materials we’ve always used in a different part of the body. Depending on the device manufacturer, they use different designs to maintain the motion in the neck.
Melanie: Who is a candidate for cervical disc arthroplasty and who might not be a candidate for this?
Dr. Parsa: Good candidates are younger individuals who have preserved good endplates in their neck, good architecture where the device can sit appropriately. If there is a severely degenerated disc that the device cannot sit on properly, I don’t feel that the individuals are a good candidate for disc arthroplasty. Also, individuals who have an infection in their neck or have osteoporosis would not be a good candidates. Most important for me is individuals who have cervical facet joint disease and deformity of their necks where your neck is not aligned properly in the first place and you need to reconstruct the cervical spine or the neck. In those cases, you want to create a stiff construct such as a fusion case. Where disc arthroplasty does the exact opposite. Also, if your pain generators are from your facet joints in the back, it is the motion that creates the neck pain and a lot of the disability associated with it. By fusing segments and that facet joint, you are helping with the pain. I like to treat every patient individually. I take a look at all of these different aspects – age, co-morbidities, how the total alignment of the spine is--and put it all together and come up with the best plan. Disc arthroplasty, I think of it as a nice, new technique that can help and offer more advantages than the classical approach for, as I mentioned, certain sub-sets of patients but not everybody.
Melanie: When looking at the discs on either side of the affected disc and protecting that adjacent disc level, what do you tell patients about what they can expect for recovery?
Dr. Parsa: What’s wonderful about the disc arthroplasty is that you don’t need a cervical collar. In fact, I promote more motion and going back to work as soon as possible. In all neck surgery, I would expect some muscle spasms in the back of the neck for a few days but a lot of my patients, after their disc arthroplasty, go back to work within a week and progressively increase their activities. So, by about three months, they are back to doing whatever contact sports or whatever they would normally do.
Melanie: That’s absolutely fascinating and really amazing. In just the last few minutes, what should people with orthopedic issues of their necks be thinking about when seeking care?
Dr. Parsa: Most importantly, the neck is an important part of your body. It can cause significant disability. My red flags are always if you have numbness, tingling or weakness in your hands, do not ignore it. If you feel your balance is off, or if you have bowel or bladder incontinence, do not ignore these symptoms. These are all red flags that you have to seek care as soon as possible. Overall, if you have significant neck pain and it’s affecting your daily life, there are many good options which are even not surgical – outside of my realm of practice. Just seeking the right care to help your recovery and give the right exercises. Almost 80 - 90% of neck pain and even mild shoulder pain associated with it, all of these can resolve non-surgically but you would want to treat it and seek advice from a professional as soon as possible so that your pain can be relieved sooner.
Melanie: Why should patients come to Palmdale Regional Medical Center for their care?
Dr. Parsa: My experience with Palmdale Regional Medical Center has been outstanding this year. They’re a new facility with a very friendly staff, responsive staff. They have a very good system. They take excellent care of their patients. The patients have private rooms. That’s one of the biggest advantages that my own patients have complimented Palmdale about in the past. At least from my standpoint, they have a designated joint and spine unit where the staff there is specifically trained in taking care of spine patients and I think that is very beneficial for our patients.
Melanie: Thank you so much for being with us today. It’s great information. You’re listening to Palmdale Regional Radio. For more information you can go to PalmdaleRegional.com. That’s PalmdaleRegional.com. Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.