Cervical disc replacement
An artificial disc instead of a fusion. Lower rates of further surgery at 7 years, but only suitable in the right anatomy.
Compare the two ›ACDF: anterior cervical discectomy and fusion
The disc pressing on your nerve or spinal cord is removed through a small incision at the front of the neck, and the gap it leaves is filled with a spacer so the two vertebrae grow together. It is the most established operation in cervical spine surgery, and for a trapped nerve it is reliably effective.
At a glance
Anaesthetic
General
Approach
From the front of the neck
Hospital stay
Approximately 3 to 5 days
Levels treated
One or two, sometimes more
Driving
Restricted for about 4 to 6 weeks
Swimming
Avoided for 4 to 6 weeks
Lifting
Heavy lifting avoided early on
Return to work
Often modified duties at first
These are the practice's published recovery figures for this operation. They depend on how your own recovery progresses, and anything specific to your case is set at your consultation.
WHAT IT INVOLVES
Remove what is pressing, then stabilise the gap
The neck is approached from the front, which sounds alarming and is in fact the gentler route: the surgeon works between the natural tissue planes rather than cutting through muscle.
1
Spacer filling the space where the disc was
2
Small plate and screws holding the level while it fuses
3
Untreated disc at the level below, left alone
01
Getting there
A short horizontal incision is made in a skin crease at the front of the neck. The surgeon passes between the windpipe and the large vessels rather than cutting muscle, which is why neck movement recovers quickly and the scar usually settles into the crease.
02
Taking the pressure off
The disc is removed, along with any herniated material or bony spur pressing on the nerve root or the cord. This is the part that fixes the problem. Everything else is about keeping the neck stable afterwards.
03
Filling the gap
A spacer goes in where the disc was, restoring the normal height and the space the nerve needs. Over the following months bone grows through it and the two vertebrae become one solid unit. That is the fusion, and it is what takes time rather than the operation itself.
WHO IT SUITS
Where ACDF is the right answer, and where it is not
A good fit when
Arm pain, tingling or weakness from a compressed nerve root that has not settled
Spinal cord compression at one or two levels coming from the front
A large bony spur or collapsed disc that also needs the height restored
Instability or deformity at the level, where fusing it is an advantage
Not the right operation when
Neck pain alone, with no nerve or cord compression to relieve
The scan finding does not match your symptoms or examination
Symptoms are improving on their own and can safely be given more time
Preserving motion matters more and the anatomy suits disc replacement
RISKS, HONESTLY
What can go wrong, and how often
ACDF is a safe operation, but no operation is risk-free. These are the ones worth knowing about, with figures where good data exists rather than the word rare.
Common, usually temporary
Difficulty swallowing
Very common in the first days to weeks because the oesophagus is gently moved aside. In large national data, around 2 to 3 in 100 patients had swallowing problems recorded as a complication.
Uncommon
Voice change or hoarseness
A nerve to the voice box runs near the approach. Temporary hoarseness happens; lasting change is uncommon.
Under 1 in 100
Nerve or cord injury
In national data, neurological complications were recorded in roughly 0.3 to 0.6 per 100 procedures. Serious injury is rarer still.
Well under 1 in 100
Wound infection
Recorded in around 0.06 to 0.22 per 100 procedures in the same data. The front of the neck heals well.
Uncommon
The fusion not setting
Sometimes bone does not bridge the level. It is more likely with more levels and substantially more likely if you smoke, which is the single biggest thing within your control.
About 1 in 9 by 7 years
Surgery at a neighbouring level
Pooled trial data found around 10.8 per cent of ACDF patients had surgery at an adjacent level within 7 years. This is the main long-term trade-off of fusing, and the main argument for considering disc replacement.
RECOVERY
What recovery involves
IN HOSPITAL
Approximately 3 to 5 days
The practice's guidance for this operation is a hospital stay of about three to five days. A physiotherapist assesses your recovery while you are in, and some patients need a period in a dedicated rehabilitation unit afterwards.
AT HOME
Looking after the wound
Keep the wound clean and dry, adapting bathing or covering it as instructed. Avoid touching it, and wash your hands before and after if you need to.
4 TO 6 WEEKS
Driving and swimming
Driving is restricted for approximately four to six weeks, depending on how recovery progresses, and swimming is avoided for four to six weeks.
GOING BACK TO WORK
Often modified duties first
Time away from work is needed to allow healing. A temporary return on modified or restricted duties is common, and heavy lifting is avoided during the initial recovery period with activity increased gradually.
Nerve pain usually improves fastest. Numbness and weakness can take months to recover, and where a nerve has been compressed a long time some numbness may persist. Recovery after cervical spine surgery goes into more detail.
Fusing a level is a permanent decision with a known trade-off
In pooled trial data, around 10.8 per cent of ACDF patients had surgery at a neighbouring level within seven years, against 4.3 per cent after disc replacement. That difference is the main long-term argument for preserving motion where the anatomy supports it, and the main reason to ask what ruled a disc replacement out before agreeing to a fusion.
COMMON QUESTIONS
The things people ask most
Will I lose neck movement?
Less than most people expect. A single fused level takes a small amount of movement out of a neck that has seven, and the remaining levels compensate. Most people do not notice a functional difference after a one-level fusion.
How successful is it?
For arm pain from a compressed nerve, ACDF is reliably effective and most people get substantial relief. It is much less predictable for neck pain without nerve compression, which is why the indication matters more than the technique.
Why from the front and not the back?
Because most compression in the neck comes from in front of the nerve or cord, from a disc or a spur. Approaching from the front reaches the problem directly, without cutting through the neck muscles at the back.
Will I need a collar?
Not routinely. Modern spacers and plates are stable enough that a collar is not needed in most cases, though one is occasionally used for multi-level surgery or in particular circumstances.
What about the level above and below?
Fusing one level does place a little more demand on its neighbours. In pooled trial data around 10.8 per cent of ACDF patients had surgery at an adjacent level within 7 years, against 4.3 per cent after disc replacement. That difference is the main reason arthroplasty is considered.
Does smoking matter?
Considerably. Smoking meaningfully reduces the chance of the fusion setting properly. Stopping before surgery is the single most useful thing you can do to improve your own result.
ALTERNATIVES
The other options worth knowing about
Posterior foraminotomy
Opens the nerve's exit from the back without an implant. An option for a single trapped nerve root in suitable anatomy.
About foraminotomy ›Non-surgical treatment
Most nerve pain settles without surgery. Unless the cord is at risk, this comes first and is given a fair go.
Do I need surgery? ›About this information
This page is general information about a procedure and is not advice about your own case. The complication rates come from the published studies listed below and describe large groups of patients. The recovery figures are the practice's published guidance for this operation, not a commitment about your own recovery. More about Dr Tollesson.
References
Cervical disc arthroplasty versus anterior cervical discectomy and fusion: a meta-analysis of rates of adjacent-level surgery to 7-year follow-up. Journal of Spine Surgery, 2020, for the adjacent-level and index-level reoperation rates.
Surgeon Procedure Volume and Complication Rates in Anterior Cervical Discectomy and Fusions. Clinical Spine Surgery, 2017, for the rates of dysphagia, neurological and wound complications.
The operation is the straightforward part. Deciding whether you need it is the part worth getting right.
A consultation will tell you whether the compression on your scan explains your symptoms, whether ACDF is the best fit, and what the alternatives would offer. A GP or specialist referral is needed for a Medicare rebate.