Cervical disc replacement

The idea

For decades the standard operation for a worn or herniated cervical disc pressing on a nerve has been ACDF: remove the disc, decompress the nerve and fuse the two vertebrae together. It is a highly reliable operation with an excellent long-term record, it remains the best choice for most patients, and it is the operation Dr. Zaidi performs most often in the neck.

Disc replacement treats the same nerve compression through the same approach from the front of the neck. The difference is at the end: instead of fusing the level, an implant is placed that lets the segment keep bending and rotating. The decompression, which is what relieves the arm pain, is the same in both operations.

Keeping motion makes sense in principle, and the evidence for it is mixed. In the lumbar spine, wear at the levels next to a fusion is well documented. In the cervical spine it is less clear: wear does appear at the levels next to an ACDF, but it also appears in necks that were never operated on, and studies have not clearly separated the effect of the fusion from normal aging of the spine. Disc replacement is chosen when the anatomy suits it.

Who this treats

Disc replacement vs. ACDF

Neither is better for everyone. It depends on which one your neck can support.

Long-term FDA investigational device trials following patients out to seven and ten years have reported outcomes for cervical disc replacement at least equivalent to ACDF. Both are well-established operations with high patient satisfaction, and ACDF suits a much wider range of patients, so most necks that need an operation are better served by it. These are average results in carefully selected trial patients and cannot predict any individual case.

Who is not a candidate

Candidacy is the most important question to ask any surgeon about this operation. An artificial disc placed in a segment that cannot support it will not move as intended.

How it's performed

1. 01

   Anterior approach

   A small transverse incision in a natural skin crease at the front of the neck. The approach passes between tissue layers to reach the front of the spine without cutting muscle.

2. 02

   Discectomy and decompression

   The damaged disc is removed and the nerve root or spinal cord is decompressed. This is the step that relieves arm pain, and it is the same whether the level is then fused or replaced.

3. 03

   Endplate preparation

   The endplates are prepared precisely and kept parallel. Disc replacement is less forgiving than fusion at this step, because implant size and placement determine how the segment moves afterwards.

4. 04

   Implant placement

   The device is positioned under live imaging, centered in both planes and seated to the correct depth.

5. 05

   Confirmation

   Final imaging confirms position and restored disc height. Most patients go home the same day or after one night, usually without a collar.

Technology used

Recovery & expectations

Setting

Same day or 1 night

Collar

Usually not required

Desk work

1–2 wks

Driving

Once off narcotics, typically ~1 wk

Physical work

6 wks–3 months

Follow-up

2 wks, 6 wks, 3 months

These are general ranges from the surgical literature and cannot be guaranteed for any one person. Risks specific to the anterior cervical approach include temporary difficulty swallowing, hoarseness and, less commonly, injury to the esophagus, vertebral artery or a nerve. Risks particular to arthroplasty include implant migration or subsidence and heterotopic ossification, where bone forms around the device and gradually reduces the motion it was placed to preserve. Nerve symptoms present for a long time before surgery may not fully resolve. Your own risks will be discussed at your consultation.

What patients say

Verbatim from public Google reviews, shown with first name and last initial. These describe Dr. Zaidi's cervical care in general. More patient reviews →

Related