As Orthopedic Patients Get Younger, Procedures Get More Advanced

A new surgical procedure is giving young patients a chance at a pain-free life for the long term.

Orthopedic issues are often thought to be an issue that only occurs as we age. However, in recent years, the patient profile for spinal issues has been getting younger. Young and middle-aged people who are healthy and active sometimes experience the same neck and back conditions as older patients. And while it is more often caused by overuse, strain or injury, rather than degeneration or arthritis, they are still seeking orthopedic treatments for relief.

For these young and middle-aged people who are suffering from disc herniation in the neck, a new procedure is restoring patients to normal function, while ensuring better long-term outcomes with lower risks of revision surgery. Cervical disc replacement is an innovative technique to treat persistent symptoms due to disc herniation.

“Cervical disc replacement is a newer technology that is designed to address two particular problems in the neck,” says Mark Palumbo, MD, chief of spine surgery at Rhode Island Hospital. “One is cervical disc herniation with resultant radiculopathy, which is arm pain, sensory changes or weakness related to nerve compression. The other is disc herniation productive of spinal cord dysfunction, or myelopathy.”

The cervical section of the spine is made up of seven vertebrae with discs between the vertebrae to cushion the bones and act as shock absorbers to allow full range of movement of your neck. The discs are made up of a tough outer layer of cartilage that holds a gel-like center. If a disc degenerates over time or through overuse, or if there is an injury to the cervical area, the outer layer of a disc can tear, allowing the soft center to rupture. The gel material can then press on the adjacent spinal cord or spinal nerves, causing inflammation and swelling of the nerve structures, and leading to pain, numbness, and tingling or weakness in the shoulders, neck or arms. While in most cases a herniated disc can be managed through pain medication and physical therapy, in more serious cases, surgery may be required.

“The advantage of disc replacement is best understood if you first compare it to the alternative,” says Dr. Palumbo.

Lumber fusion
Lumber fusion

The alternative, a procedure called spinal fusion has been performed for decades. This treatment involves surgically removing the damaged cervical disc to relieve the pressure on the spinal cord or nerves. After removing the disc, to fill the gap of the now-removed disc, a piece of bone graft or a metallic device is implanted as a spacer between the two vertebrae and a metal plate is applied over the bones to hold them together and stabilize the spinal segment. This surgery, while a good option for many patients, immobilizes part of the spine, changing the way it can move, and puts additional strain on the vertebrae above and below the fused portion. In some cases, the spine does not heal after the procedure and may require additional revision surgeries.  

Cervical disc replacement is a technique very similar to knee replacement or hip replacement procedures in orthopedics. A device made up of two metallic pieces separated by a piece of biomedical grade plastic is implanted in place of the damaged disc. Like an artificial knee or hip joint, the mobile implant takes the place of the disc, allowing retained fluid movement and range of motion of the spine in all directions. Moreover, this procedure does not require a plate to be fused to the surrounding vertebrae.

“We’re not fusing the vertebrae so it eliminates the complication of non-healing of the fusion,” says Dr. Palumbo.  “Studies show there are fewer cases of revision surgery needed following disc replacement.”

“An advantage of retaining motion at that segment is that it reduces mechanical stress at the level below and level above the disc by maintaining normal motion of the entire spine, mitigating the risk of accelerated degeneration of the surrounding vertebrae,” adds Dr. Palumbo.

It is precisely this advantage that makes it such an optimal treatment option for younger patients.

“If you had fusion at very young age, and you’re going to live for multiple decades, the odds of you developing a problem with the surrounding vertebrae and requiring additional surgery is high,” Dr. Palumbo notes.

Taking into account how many more decades of an active life younger patients have ahead of them, a fusion procedure may not always be the optimal option. The innovative cervical disc replacement procedure was developed to maintain as much of the normal mechanics of the spine as possible, so patients can maintain their highest level of function for the longest period of time going forward.

“In a young person, the pain they seek treatment for is almost always due to soft disc herniation, not bone spurs or arthritic change, which means everything else in the spine is normal and healthy,” says Dr. Palumbo. “The best candidate for a cervical disc replacement is a young or middle-aged person with a high level of function, without very advanced arthritic change in the spine.”

While cervical disc replacement has been around for nearly 15 years, it is still quite a new, innovative procedure when compared with other treatments.

“I have been doing disc replacement for about 12 years,” says Dr. Palumbo, “I offer it to about 5 to 10 percent of patients with cervical radiculopathy.”

But as younger and younger patients are seeking orthopedic treatments for their pain, new technologies will continue to be developed to meet the needs of this unique group. Cervical disc replacement has already come a long way since its start – newer disk replacement devices are becoming available and the instrumentation to insert the devices have improved the ease and safety of the operation just in that time. As these young patients have years ahead of them to live active, full lives, the procedures will continue to advance to ensure those years remain active and pain-free.

Learn more about spine treatment at the Lifespan Orthopedics Institute