Cervical Disc Replacement

As in ACDF, the underlying problem is a disc or bone spur in the neck pressing on a nerve root, causing arm pain, numbness or weakness, or pressing on the spinal cord and causing myelopathy. Where these symptoms are significant and do not settle with non-operative care, surgery to relieve the pressure can be considered. The particular appeal of disc replacement is for younger, active patients with a well-preserved segment, where keeping motion may be advantageous.

The approach is the same natural plane at the front of the neck used for ACDF. The affected disc is removed and any material pressing on the nerve or cord is cleared. Rather than filling the space with a fusion spacer, an artificial disc — designed to allow movement — is fitted precisely into the cleared disc space. The device restores disc height and holds the nerve exit open while permitting the segment to bend and rotate, aiming to reproduce more natural mechanics than a fusion.

Cervical disc replacement can be considered for cervical radiculopathy or myelopathy from a disc problem at one or, in some cases, two levels, where the compression is coming from the front and the segment is otherwise suitable — with reasonable alignment, preserved movement and without significant arthritis or instability. It is often favoured in younger, active people. It is less suitable where there is marked degeneration, deformity, instability or extensive bony overgrowth, in which case a fusion may be the better choice. The decision is individualised.

Cervical disc replacement is unusually well studied for a newer technology. Multiple randomised controlled trials with long-term follow-up, and meta-analyses pooling thousands of patients, show that in appropriately selected patients arthroplasty gives results at least as good as ACDF for relieving symptoms, with the added potential benefit of preserving motion and possibly reducing the rate of problems at adjacent levels over time. The balanced view is that, for the right patient, disc replacement is a well-evidenced motion-preserving alternative to fusion — while fusion remains the better option in many other situations.

The operation is usually performed under general anaesthetic, often with a short hospital stay, and recovery is broadly similar to ACDF, with a sore throat or mild swallowing discomfort common in the early days. Because the segment is not fused, movement is generally encouraged as comfort allows. Arm symptoms often ease quickly once the nerve is decompressed. As with any operation there are risks, which are discussed fully beforehand. Whether disc replacement or fusion is the better option depends on the individual and is decided together.

• —Findlay C, et al. Total disc replacement versus ACDF: systematic review and meta-analysis of 3160 patients across 14 RCTs. Bone Joint J 2018. (PMID 30062947)
• —Sasso WR, et al. 20-year clinical outcomes of cervical disc arthroplasty: a prospective, randomised, controlled trial. Spine 2024. (PMID 37644726)
• —Radcliff K, et al. Long-term evaluation of the Mobi-C cervical disc: randomised, prospective, multicentre trial with 7-year follow-up. Int J Spine Surg 2017. (PMID 29372135)
• —Gornet MF, et al. Cervical disc arthroplasty with Prestige LP versus ACDF at two levels: 24-month RCT results. J Neurosurg Spine 2017. (PMID 28304237)