The PRESTIGE® Cervical Disc For The Neck — An Interview With Dr. Richard Fessler

Me: Dr. Fessler, how was the concept of a replacement cervical disc created?

Dr. Fessler: Well, the concept came out of many years of practice in which we fused the cervical spine; that is, we took away motion in order to treat the herniated disc, or other another condition such as fracture, tumor or infection. Over time, we recognized that fusing parts of the spine could have consequences to the areas around it. That is, they tend to wear out a little bit faster. That led to the idea that if you can maintain motion in the area you are operating on, you should be able to allow the rest of the spine to age normally rather than faster than it otherwise should.

Me: What is the PRESTIGE® Cervical Disc?

Dr. Fessler: The PRESTIGE® Cervical Disc is a composite of two pieces, both made of stainless steel, designed to both roll and tilt. What it does is replace the disc that you are taking out. Rather than fusing the spine, the PRESTIGE® Cervical Disc is designed to provide for motion at the treated vertebral segment.

Me: Who is this designed to treat?

Dr. Fessler: This disc is specifically designed to treat people who have degenerative disc disease at one level. Mostly, we get our disc disease in the middle of the cervical spine, from our C4-5 disc down to our C6-7 disc. It is particularly designed for people who are not at the point where their spine is fusing all by itself. For example, if you're 75 years old and you start having neck problems, it's probably not going to be a herniated disc but rather changes associated with aging. With aging you tend to lose motion naturally. However, if you're 45 years old and you are out playing baseball with your children and you've swung too hard after not warming up and you herniate a disc in your neck, you might be an ideal candidate. Rather than fusing your spine, we could give you an artificial disc.

Me: You mentioned the aging process. Is that where degenerative disc disease comes into play?

Dr. Fessler: That's correct.

Me: What is cervical degenerative disc disease? Is it only seen in older patients?

Dr. Fessler: No, it's seen in virtually any age group. You see different types of problems depending upon your age. If you're young, you're more likely to get something like a herniated disc unless, of course, you have a car accident or something and get a herniation or fracture. As you get older, rather than disc herniation, what we see is ligament thickening and bone thickening, called bone spurs or osteophytes. When you put those things together, they tend to take up the space that's otherwise available for the spinal cord and the nerve roots. That's what we call spondylolisis.

Me: What are some of the symptoms patients typically experience before you'll recommend the PRESTIGE® Cervical Disc?

Dr. Fessler: Very commonly, a patient will come in and will give you some kind of history of bending and twisting or lifting something heavy or being in a car accident or taking a fall, and they will say right after it happened, "My neck was stiff and sore, but it wasn't until the next day that I started noticing that my fingers were numb and I had pain going from my neck into my shoulder and down my arm all the way into my hand, and that just hasn't gone away." Usually before we ever get to the point of recommending any kind of surgery, we will try a course of reducing activity, medications to decrease swelling and treat pain, just to give it some time to see if it will go away on its own. If that fails, often we will try injections such as epidural steroids and physical therapy, stretching and strengthening exercises. If those things fail and you still have the pain or, for example, if you're progressing in your symptoms, your pain or numbness is getting worse or you're showing weakness in your hand or arm, that's when it may be time to consider surgery. In the past, our only option was fusion. Now we have the option of giving you an artificial disc.

Me: So, it's something you progress towards, not jump right into?

Dr. Fessler: Right — we never jump right into surgery.

Me: In layman's terms, how would you compare the PRESTIGE® Cervical Disc to traditional spinal fusion?

Dr. Fessler: In terms of the procedure itself, it's almost identical. The approach is the same, the incision is about the same, the things you do to the disc are the same until the very last step of the operation. Then, instead of putting in a piece of bone and a plate to cover that — to get the vertebrae to fuse, or grow together — we put in the artificial disc. It's usually an outpatient or an overnight hospital stay.

Me: What are the benefits to the patient?

Dr. Fessler: The PRESTIGE® Cervical Disc is designed to permit motion. The procedure itself, whether you do fusion or the disc implantation, will generally relieve neurologic symptoms — the pain, weakness and loss of sensation. Either procedure is very good for that.

Me: As with any surgery there are risks. What are the risks associated with the PRESTIGE® Cervical Disc?

Dr. Fessler: By and large, these are very safe operations. This is probably the second most common operation we do; that is, surgery on the anterior cervical disc, whether for disc replacement or fusion. But as with any operation, it carries all the potential risks that any operation on the spinal cord could, including death. That's only one in about a million, but it is something that every patient has to know. Spine surgery also has a risk of paralysis. Again, extremely rare but still a risk. One of the more common risks we see is infection. Infection rates, in general, are somewhere between 1% and 3%. In the neck, the risk tends to be lower because there is much less soft tissue disruption and much less area for infection to actually start. Also, anything you put in could wear out or come out; for instance, a screw could come loose. That's also in the range of a 1% to 3% chance. When you're operating in the front of the neck, there's also the risk of injury to one of the structures in the neck, such as the trachea, esophagus, carotid artery or jugular vein, but this is extremely rare. One of the more common things we see is injury to the nerve that crosses the neck and goes to the vocal cords, which gives you a raspy voice. This happens about 3% of the time, whether with an artificial disc or fusion — it's just the surgical approach itself. Of those 3%, two out of the three are temporary, it's rarely permanent.

Me: What can you tell us about the evidence on the safety and effectiveness of the PRESTIGE® Cervical Disc?

Dr. Fessler: According to our study, the safety is the same as that of a standard fusion. In terms of effectiveness, the disc was superior to fusion in overall success and neurological success at 24 months. The overall effectiveness score is a composite of a number of things — pain relief, and whether there was any neurologic injury or need for another operation, to name a few. Putting all those scores together for the artificial disc and for the fusion, the artificial disc was actually superior to the fusion at 24 months. We were very happy with that. The other area where the disc was actually better was in neurologic improvement.

Me: What would you advise patients who might be considering surgery with the PRESTIGE® Cervical Disc?

Dr. Fessler: First, you want to go to a doctor who has not only been trained to implant the PRESTIGE® Cervical Disc, but who is also very experienced in surgery on the anterior cervical spine. You also want to go to a doctor who will give you a very thorough assessment to determine whether you are a good candidate for the disc or for a fusion, because you should get what will be the best procedure for you.

Me: Dr. Fessler, thank you for your time and continued success in working with your patients and the cervical disc.