Cervical Disc Replacement versus Anterior Cervical Discectomy Fusion (ACDF)

Spine care has advanced at a rapid pace through technology and innovation. There is a tremendous opportunity to improve the quality of life of patients who suffer from spinal disorders. Conditions that affect the neck or cervical spine can cause severe pain, weakness, numbness, and disability for patients. For many years, the gold-standard treatment has been a procedure known as anterior cervical discectomy fusion (ACDF). However, in recent years, an alternative treatment has demonstrated excellent outcomes.

Cervical disc replacements are a motion sparing treatment option for patients suffering from cervical spinal disease. This technique has a 15-year track record and has demonstrated excellent outcomes in the properly selected patient. It has the advantage of avoiding a fusion and preserving the natural motion of the neck.

Dr. Segal has expertise in performing cervical disc replacement surgery. He has both researched and published in peer reviewed medical journals on cervical disc replacements. His research demonstrated clinical safety of performing cervical disc(opens in a new tab) replacement surgery in an outpatient setting. He also performed some of the first biomechanical studies(opens in a new tab) on disc replacement hybrid fusion models.

Cervical Disc Replacement Surgery

Cervical disc replacement (CDR) is also known as total disc replacement(opens in a new tab) (TDR), cervical disc arthroplasty (CDA), or total disc arthroplasty (TDA). 

CDR is a motion-sparing treatment option for patients suffering from conditions like:

• Cervical disc herniations
• Cervical stenosis
• Cervical radiculopathy
• Cervical myelopathy

A patient’s natural cervical disc can absorb a compressive load while providing a high degree of flexibility and motion. Replicating this natural form and function with an artificial disc can prove to be challenging. With recent advancements in spine care, several artificial disc options are now available.

The CDR Surgery Procedure

The cervical disc replacement is an implantable device. Surgery is performed through a small incision with a muscle-sparing technique. The herniated disc is removed, and the spinal cord and nerves are then decompressed. The disc replacement device is then implanted in place of the diseased disc. This procedure can often be performed safely in an outpatient setting.

The Goals of Cervical Disc Replacement Surgery

“Cervical disc replacements are an excellent option for the right patient. There are two main goals of cervical disc replacement surgery: relieve nerve compression and maintain motion at the repaired spinal level,” – Dr. Segal

Relieving Nerve Compression

When discs herniate, the nerve roots and spinal cord have less room to function. The resulting symptoms can be crippling and include pain, numbness/tingling in the arms and hands, weakness, loss of hand dexterity and loss of balance.

Removing the damaged cervical disc and replacing it with an artificial one relieves pressure on nerves that have become compressed, giving them space to function properly and heal. 

If a patient has been suffering from other symptoms, including problems with mobility, bladder or bowel control, or coordination, relieving pressure on the spinal cord may resolve these issues or prevent their progression.

Maintaining Motion at the Repaired Spinal Level

A patient’s natural biomechanics can be retained throughout the spine by replacing a damaged disc with an artificial one. It’s important to note that while an artificial disc can help maintain a person’s range of motion, it will not create or improve motion where there was none. 

Anterior Cervical Discectomy Fusion (ACDF)

Traditionally, a person with cervical stenosis caused by a disc herniation receives an anterior cervical discectomy and fusion (ACDF). This tried-and-true treatment has repeatedly yielded excellent outcomes.

The surgeon removes the one disc (single-level) or more (multi-level) that causes symptoms during this procedure. The empty space between the vertebrae is not filled with an artificial disc, as with CDR. Instead, a spacer bone graft is inserted to prevent the vertebrae from collapsing. The surgeon then fixes the graft in place with metal plates and screws.

As the body heals, new bone will grow around the graft, and eventually, the two vertebrae will be joined and form one solid piece of bone.

The ACDF Surgery Procedure

During anterior cervical discectomy and fusion, herniated or degenerative discs are removed. The least invasive way to access a damaged disc is from the front (anterior) of the spine because surgeons can access the disc without disturbing the spinal nerves, neck muscles, or spinal cord.

The Goals of Anterior Cervical Discectomy and Fusion

The main goal of ACDF is the same as the goal for CDR: to relieve symptoms in the patient by removing the damaged disc or discs. This disc removal eliminates spinal compression, which reduces pain, numbness and dysfunction. While one of the goals of CDR is to replace the damaged disc with an artificial one to preserve a patient’s range of motion, ACDF uses a bone graft instead. This fuses the diseased disc space which results in loss of motion there. 

Choosing Between Cervical Disc Replacement and Anterior Cervical Discectomy Fusion

ACDF surgery effectively treats pain and neurologic deficits that stem from nerve root inflammation and spinal cord compression, just as cervical disc replacement surgery does. Both procedures remove problematic discs, but they differ in some crucial ways.

To summarize, ACDF fuses the vertebrae across the diseased disc resulting in loss of motion at that spinal level. On the other hand, CDR aims to preserve range of motion at that level and avoids bone grafting.

Benefits of Cervical Disc Replacement

In cases where both procedures are viable options, patients may consider some of the potential benefits of CDR:

• More natural neck motion
• Reduced risk of adjacent spinal segments developing disc issues
• Elimination of complications associated with bone graft, screws, or plates
• A faster return to neck movement after the procedure

Not every patient is a candidate for CDR, so it’s also important to understand the potential benefits of ACDF.

Benefits of Anterior Cervical Discectomy and Fusion

For patients who are not candidates for cervical disc replacement, the ACDF procedure holds many benefits, including:

• Longer treatment history and success
• More data available to back up long-term effectiveness and safety
• Suitable for patients with severe spinal degeneration who have already lost motion 

Regardless of which procedure the patient chooses, the goal is the same. Studies demonstrate that the relief achieved after both procedures can last for decades.

Contact the Orthopedic Specialists of Southwest Florida

If you are a patient suffering from neck or cervical disease, you should consult with a spine specialist with expertise in disc replacement to determine whether this procedure is right for you. Schedule an appointment by calling (239) 334-7000 or online by filling out this short contact form.