Non-fusion Surgeries of Lower Cervical Spine

Traumatic, degenerative, or malignant conditions that involve the removal of intervertebral discs or vertebral bodies often necessitate anterior spinal fusion, which is among the most frequently performed procedures on the cervical spine. For single-level surgery, autogenous bone grafting has demonstrated a fusion rate of 95% or higher.

The utilization of artificial spacers or bone substitutes has alleviated donor-site pain, while anterior cervical plating has been associated with increased fusion rates and eliminated the requirement for external immobilization following surgery.

Despite achieving satisfactory results, it is theoretically possible that spinal fusion places additional strain on neighboring segments and potentially speeds up degenerative processes.

Contrarily, there is an argument that degeneration of adjacent segments is a natural course of the disease in individuals who are genetically susceptible. Nonetheless, it remains crucial to prioritize the preservation of functional spinal unit mobility following disc excision or non-fusion procedures.

The concept of substituting the intervertebral disc is not a novel one. Within the last five decades, more than 100 designs, encompassing simple metallic balls to intricate composite polymers with various metal backings, have been documented.

As the comprehension of the biomechanics and kinematics of the functional spinal unit has improved, modern designs have become more advanced and closely mimic the natural mechanics of the spine.

While the immediate outcomes seem to be acceptable, there is still a lack of available medium- and long-term results. Interestingly, the most favorable clinical results were observed in segments that naturally underwent fusion, which raises the irony that the artificial disc, despite its cost, primarily functions as an expensive intervertebral spacer for fusion purposes.

Several prospective randomized controlled trials have asserted the superiority of artificial disc replacements in terms of results. However, it is worth noting that the control group in these trials comprised standalone intervertebral cages, which are widely recognized for yielding unfavorable outcomes. The cervical spine inherently presents a less hostile environment compared to the lumbar region when it comes to various conditions.

Disc replacement should theoretically have a higher likelihood of success in the cervical segments due to notable differences in factors such as disc size, loading forces, facet joint anatomy, and kinematics when compared to the lumbar segments.

Undoubtedly, the literature on the cervical spine has seen a rise in the number of reports in recent years, approaching the level of those concerning the lumbar spine. Generally, a range of approximately 5º to 7º of segmental motion can be retained.

However, it remains uncertain whether this is the contributing factor to the limited occurrence of adjacent segment degeneration, as most of the follow-up periods have been relatively brief. Hence, there is a growing concern regarding the implantation of artificial discs in progressively younger patients who have several decades of life expectancy remaining.

Insights into the future of artificial disc replacement can potentially be gleaned from the historical progression of joint replacement for hips and knees. The higher the level of resemblance achieved in replicating the anatomy and kinematics of the joint, the greater the likelihood of success.

Over time, the fixation methods of the implant to the recipient bed have undergone evolution, including various generations of cement pressurization, surface in-growth, anatomic press-fitting, with or without screw augmentation, and more. Wear debris osteolysis, mechanical loosening, and implant migration impose limitations on the long-term success of artificial disc replacement.

The frequency of revision surgeries, if not surpassing primary implantations, is increasingly common in the field. The endeavor to reconstruct major bone defects is challenging and entails the possibility of adverse outcomes. Patients may need to be prepared to undergo multiple revision surgeries if such a scenario occurs in the cervical spine after an artificial disc replacement.

Surgeons possess the capability to salvage these situations, restore bone stock, or determine if the bridges have been irreversibly compromised. It is crucial to remember the primary concern, which is to avoid endangering the spinal cord at all costs.

At the University of Hong Kong, a team has adopted a unique approach to address this matter, examining the viability of biologically regenerating or replacing the disc while maintaining its mobility.

The team firmly upholds the belief that the most optimal design for a disc is one that has been naturally provided. Taking inspiration from the achievements seen in major organ transplants, a series of experiments have been conducted on primates to investigate the feasibility of intervertebral disc autografting, allografting, and fresh frozen allografting.

The implanted disc possesses the potential to fulfill the objectives of achieving mechanical stability and preserving mobility within the segment, all while minimizing the risk to neural tissues. However, during the initial months, there is a decrease in the height of the transplanted disc, implying a degenerative process. A study has been conducted on humans in Beijing by the team since the year 2000, and the outcomes have demonstrated remarkable promise.

The healing of the bony endplates is nearly assured, and there is no indication of any immunoreactive response. Apart from the anticipated findings from the animal studies, two additional phenomena have been identified.. The first phenomenon observed was that malpositioned allografts were capable of remodeling over time to achieve a completely normal position.

Unlike artificial disc replacements, where the misplacement of an implant can lead to failure, such an outcome would not have been feasible in this case. Currently, studies are being conducted to determine whether the restoration of anatomical alignment also results in the restoration of kinematics.

Furthermore, during the post-5-year follow-up period, a significant proportion of the transplanted discs exhibited a prominent T2 signal within the nucleus pulposus, indicating active metabolic processes and adequate hydration within the transplanted discs.

From a clinical perspective, the transplant yielded motions that were on par with those achievable through artificial disc replacement. Moreover, none of the cases led to unintended fusion, demonstrating the success of the transplant in maintaining segmental mobility. There were no instances of herniation in the transplanted disc, segmental instability, or adjacent segment degeneration observed. Neither osteolysis nor implant migration were observed.

Although the research group has not encountered any instances necessitating revision surgery thus far, they anticipate that if the need arises, it can be adequately addressed through alternative options such as another allograft transplantation, artificial disc replacement, or the well-established spinal fusion procedure. It is crucial to address concerns regarding the sourcing of allografts, screening for transmittable diseases, and implementing reliable preservation technology, as these are all significant factors to consider.

In order to achieve biological repair or regeneration of the disc, it becomes imperative to enhance the understanding of the underlying molecular mechanisms that contribute to disc degeneration.

Consequently, the research team at the University of Hong Kong has established an extensive research program that focuses on investigating the impact of epidemiology, genetics, functional genomics, proteomics, and nutrition on the nano-structure and mechanics of the disc.

The studies reported in literature firmly maintains the viewpoint that addressing degenerative disc disease through non-fusion strategies, such as biologic repair and/or disc replacement, plays a crucial and noteworthy role in managing the condition. It is anticipated that artificial disc replacement will continue to be a prominent approach for a considerable period until alternative methods are further advanced.

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Based on 107 reviews
Dr. Nakul Karkare is awesome! And patriotic! Thank you, Dr. Karkare for displaying the American Flag in your waiting room, honoring and mourning our military personnel, this Memorial Day, who died while serving in the United States Armed Forces.
00:52 30 May 23
Excellent and skilled orthopedic practice specializing in joint replacements. Dr Karkare was trained at the Hospital for Special Surgery and has excellent results, as do his associates!! Would gladly refer family members to the practice!!
00:24 30 May 23
I had such a wonderful experience with Complete Orthopedics in Stony Brook. Not only did Dr. Kuo fix my broken wrist with such kindness and care, but the office staff, including Billing, Reception and the X-Ray Technician, was always so helpful, going out of their way to ensure that each patient felt welcome, answering any questions with a smile, and ensuring any issues with insurance/billing were handled with the utmost professionalism. I highly recommend their practice!
Victoria DeMatteo
19:49 10 May 23
I'm very happy St. Catherine's sent me to this office for treatment after I broke my collar bone! Unfortunately the break was too severe to repair on its own and I had to have it rebuilt a week after the injury. Dr. Vaksha did a great job fixing it. I'm three months out, and I have full use of the arm and shoulder. The whole office staff is very professional, accommodating, and welcoming. I hope to not need orthopedic services again, but Dr. Vaksha will be my number one choice if I or anyone in family suffers such am injury.
Tina Rivera
20:42 08 May 23
No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18

I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.

Please take a look at my profile page and don't hesitate to come in and talk.