Endoscopic cervical arthroplasty / total disk replacement (TDR)

Most cases with a cervical disk herniation that cause neck and/or radiating arm pain can usually be solved with cervical endoscopic spine surgery without placing an implant or device into the spine.

However, in some cases with advanced and severe disk degeneration causing deformity of the cervical spine (kyphosis), an implant can be necessary to restore the correct alignment of the cervical spine. Cervical total disk replacement (TDR) allows resolving this kind of pathology while preserving and/or restoring the movement of the cervical spine.

A typical symptomatic pathology of the cervical spine can cause neck and/or radiating pain into the arms, headache and exceptionally also some dizziness.

Dynamic X-ray films in extension (left image) and flexion (right image) showing a single-level TDR after full-endoscopic cervica arthroplasty. Note the movement of the TDR at the operated level.

Classic open cervical surgery usually requires a wide skin incision and blunt dissection of the neck’s soft tissue. The use of a retractor to expose the cervical spine increases pressure on the surrounding tissue, increasing the risk of post-operative dysphagia (swallowing problems and pain) and hoarseness.  Moreover, there is an increased risk of post-operative bleeding, which is why many hospitals still have patients at least on night at the Intensive Care Unit (ICU) for monitoring after open surgery.

X-ray films of the cervical spine in extension (left image) and flexion (right image) showing movement of a two-level cervical TDR. 

Dr. Morgenstern is a world-wide renowned surgeon in full-endoscopic spine surgery that allows placing a full-endosocpic TDR of the cervical spine with a small skin incision of less than 2 cm length at the patient’s neck.

Full-endoscopic TDR surgery does not require a retractor, hence minimizing the risk of post-operative dysphagia (swallowing problems) and hoarseness. The ultra-minimally invaisve nature of ful-endoscopic procedures also minimizes the risk of post-operative bleeding, infection and scarring. Full-endoscopic cervical spine surgery does NOT require post-operative monitoring at the UCI with hospital discharge usually in less than 24 hours after surgery.

X-ray films of the cervical spine showing a cervical TDR (red circle) in flexion (right image) and extension (left image) of the neck. Note how the level with a cervical TDR preserved the movement of the cervical spine while the fused levels below do not move.

Full-endosocpic TDR surgery consists of a full-endoscopic diskectomy to remove the degenerated disk and decompress the neural structures, like the nerves and spinal cord. After the disk has been prepared,  the TDR device is placed at the targeted level under fluoroscopic control.

Picture of the scar of a typical skin incision of less than 2 cm length at the front of the neck after full-endoscopic TDR surgery.

Post-operatively, the pain usually recedes after a few hours and the patient can be discharged from the hospital in less than 24 hours.