A Modern Approach to Chronic Neck Pain at Bone and Joint Institute

If you experience chronic neck pain, you’re not alone. In fact, more people than ever before are suffering from neck pain. A recent study found, “The number of prevalent cases of neck pain increased from 164.3 million […]  in 1990 to 288.7 million […] in 2017.”

The good news is that while prevalence is increasing, orthopaedic surgeons’ tools and skills for addressing chronic neck pain are also keeping pace. We recently sat down with John Klekamp, M.D. of Bone and Joint Institute of Tennessee to learn more about the quality surgical care that patients with chronic neck pain, numbness or weakness are receiving at Bone and Joint Institute of Tennessee.

Dr. Klekamp is one of several surgeons who specializes in a surgical procedure called Cervical Disc Replacement (also known as “cervical disc arthroplasty”).

The patients that Dr. Klekamp sees often come into his office because of pain, weakness, numbness or lack of sensation in a limb or their body. If patients do not find their symptoms resolved through more conservative therapies, they may be candidates for cervical disc replacement.

Williamson Source: What causes issues like neck pain or numbness or weakness of the limbs?

Dr. Klekamp: Your spine, particularly in the neck – “cervical” meaning “neck” – is made up of blocks of bone stacked on top of each other with soft discs in between. The disc anatomy can be thought of as a jelly donut with a hard crust on the outside and a soft gel on the inside that allows shock absorption. Over time, these discs can age and the outer area of the disc can crack or split and the gel on the inside can push back and pinch nerves. Or, the discs may develop bone spurs and push back on the individual nerves that go down the arms (radiculopathy); or they may push back on the spinal cord and cause irritation and compression (myelopathy).

WS: What options do these patients have?

Dr. Klekamp: There are multiple treatment options for these conditions, which can include medication, anti-inflammatories, and physical therapy. If that doesn’t work we oftentimes will do epidural steroid injections, which are shots of cortisone around the spinal areas affecting nerves. If all measures of conservative measurement are not successful, then we consider surgical intervention, such as cervical disc replacement.

WS: What Is Cervical Disc Replacement?

Dr. Klekamp: This is a procedure I do with a lot of patients and have excellent outcomes. Cervical disc arthroplasty is a replacement of the disc within the spinal column.

The standard cervical intervention over the past fifty years has been a procedure called anterior cervical discectomy and fusion. That’s a procedure where we make an incision on the front part of the neck and go to the disc – or discs – that is pinching nerves. We remove the disc or put bone or some type of fusion device into the disc space to fuse it. Fusion means that the disc that was previously moving is now fused, so there is no motion at that disc level anymore. This is done in hopes to stop any further nerve compression and stabilize that segment(or segments).

Fusion has been very successful over the last 50 years, but an issue that we have identified is adjacent segment disc degeneration, meaning that when you remove a disc or several discs in the neck and stop motion at that level, it can then place stress on the adjacent discs surrounding the area of the fusion. We see this after cervical disc fusion at about a rate of 3% per year. These are discs that become symptomatic to the point where patients are then having nerve or spinal cord compression and becoming symptomatic around where they had their previous surgery.

In order to address this problem the procedure of a cervical disc arthroplasty was developed – the idea being that instead of fusing the disc that is causing nerve compression, we replace it with a mobile device. This concept has been around for decades and, in fact, we use it very successfully when we replace hips, knees, shoulders, and ankles.

WS: Who is a candidate?

Dr. Klekamp: Not all patients are candidates. The contraindications for undergoing cervical disc arthroplasty are evidence of previous surgery at that level, ongoing infection, osteoporosis or weak bone, or facet arthritis.

Facets are the joints in the back of the neck. If this is considered to be one of the key pain generators, then cervical fusion is the better option because it stops the motion of the facet joints and therefore increases the chance of a better outcome.

WS: Have there been any recent developments or changes in how artificial disc replacement is done?

Dr. Klekamp: No, but we have better data and economic benefits. Cervical disc arthroplasty has been being performed for the last 15 years fairly routinely. We now have very good 12-year data from research studies on patients who have undergone cervical disc arthroplasty. There are several designs and all of them have been tested against cervical disc fusion and appear to be very successful.

The research data would show that there are similar short-term outcomes and some studies even show better results in the cervical disc arthroplasty group. But what we now recognize is that there are much less reapportions in patients who have undergone disc arthroplasty-almost two-thirds less.

Regarding the economic side, early on, because the initial cost is higher for the procedure and the implant is more expensive, the question was whether there would be long-term economic benefits. We are now seeing that there are. Patients have less operations, return to work sooner, and enjoy equivalent short-term gain but better long-term gains.

WS: What is the recovery process like?

Dr. Klekamp: This is one of the biggest benefits. We restrict neck motion in patients who have undergone cervical discectomy and fusion. Oftentimes we’ll put them in a hard cervical collar – oftentimes for several weeks. With cervical disc arthroplasty, once the initial post-surgical discomfort has resolved, patient motion is not restricted. Usually I will see patients back within 4-6 weeks from their surgery and lifting any restrictions so that they’re able to return to work and life quicker.

See a Physician at Bone and Joint Institute for Neck Pain

For more information about surgery of the cervical spine, contact John Klekamp, M.D. at Bone and Joint Institute of Tennessee. Call (615) 791-2630. You can also schedule an appointment online.

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