When James Baisley visited the Bethesda office of Johns Hopkins neurosurgeon Shih-Chun “David” Lin, his left arm was weak. It would get numb if he laid in certain positions, and it would suddenly cramp up and lose strength at times when he lifted an object. The issue had started three years prior, and even after physical therapy, his ailments had returned and intensified.
“I got about 70% of my muscle mass back, but it just kept getting worse,” says Baisley, a 39-year-old Bethesda resident who worked out and played sports regularly, and had boxed for many years. “If I tried to open a door with my left arm, my arm kind of collapsed on itself. There were clearly some nerve issues there.”
Before he saw Lin, Baisley had an electromyogram — a test that measures muscle response or electrical activity in response to a nerve’s stimulation of a muscle — performed by neurologist Omid Motabar, and an MRI. The tests showed problems in several parts of Baisley’s cervical spine (neck area), and a pinched nerve as a result of a herniated or bulging disk.
A cervical disk — the pad that acts as a cushion between two vertebrae — was bulging, pressing on nerves connected to Baisley’s left arm. The disk was between his C6 and C7 vertebrae, which bear most of the weight of the head and support the lower neck.
Lin, Suburban Hospital’s chief of neurosurgery, knew he would have to operate or Baisley risked permanent pain, weakness and numbness in his left arm.
Rather than using the standard surgical approach — an anterior cervical diskectomy and fusion (ACDF) —Lin performed a minimally invasive artificial cervical disk replacement, an outpatient procedure that preserves a patient’s range of motion and promotes faster recovery.
During ACDF surgery, the bulging disk is removed and the two vertebrae are fused together, restricting the patient’s movement. In artificial disk replacement surgery, a disk made out of titanium with a core of plastic or similar materials replaces the removed disk. It is performed using a surgical microscope, with an incision about 1-inch long in the patient’s neck.
“Medical studies repeatedly show that the outcomes of artificial disk replacement are equivalent to those of fusion and, in some cases, superior,” says Lin. “But artificial disk replacement offers a number of advantages over fusion.”
In addition to preserving range of motion, those advantages include the ability for doctors to prescribe anti-inflammatory medications rather than narcotics after surgery (anti-inflammatories slow down bone healing in ACDF surgery, which is unfavorable); patients do not need to wear a neck brace after surgery and typically have less postoperative pain.
The best candidates for artificial cervical disk replacement are patients whose spines are anatomically intact rather than distorted. Fusion remains the more commonly performed procedure, even in Lin’s practice, because fewer patients qualify for artificial cervical disk replacement.
Baisley had enough space between his vertebrae to allow for artificial disk replacement rather than fusion, which Lin says is one of the biggest factors in determining patient eligibility. The other issues in his cervical spine, partially due to previous shoulder dislocations and rotator cuff surgery, were milder and also favored using artificial disk replacement, as fusion has a higher risk of worsening issues in other vertebrae.
Baisley’s issues resolved almost immediately after surgery, and he was back in the gym working out within two weeks.
“After the procedure, I felt great; had no pain at all. I took zero painkillers,” says Baisley. “Two weeks later, I was back in the gym doing pullups, pushups, chest presses and anything that I wanted to do. And ultimately, my neck feels good. I don’t have much of a mark or scar; it healed really well.”
Minimally Invasive Is the Key
Lin also performs minimally invasive microdiskectomies for patients with herniated disks in the lower back region (lumbar spine). Like artificial cervical disk replacement, this outpatient procedure also involves making a small incision for surgery, promotes faster healing and reduces postoperative pain.
In microdiskectomies, Lin makes an incision about a half-inch long and uses imaging to guide him. He works through a series of tubes that gradually get wider in order to stretch the tissue and access the bulging disk and/or bone spurs that need to be removed. This method is used instead of opening up larger areas of skin and tissue as is done in the more traditional approach, which potentially increases infection risk and could result in a longer recovery period.
“The key in neurosurgery is that we are always trying to be less invasive,” Lin says, “and with that, striving for better accuracy.”
While many patients with bulging disks can heal with nonsurgical treatment, those who have neurologic issues such as muscle weakness or numbness that can be confirmed via MRI are good candidates for microdiskectomy.