Cervical Disc Replacement: Motion-Preserving Alternatives to Fusion
Learn about cervical disc replacement as a motion-preserving alternative to fusion, comparing outcomes, risks, and recovery expectations.
Introduction
Cervical Disc Replacement (CDR) is a modern alternative to traditional Cervical Spine Fusion that first saw widespread use beginning in the mid-2000s (1). CDR is used to treat radiculopathy or spondylosis caused by cervical disc herniation and has grown in popularity and availability since its first introduction. Since the first device used for total CDR was approved by the FDA in 2007, an additional eight devices have been approved for treating single level disc disease, with two other devices now approved for management of bilevel disease (2). This article compares CDR to traditional fusion methods (most notably ACDF), explains some of the risks and complications possible with CDR, and discusses expectations for recovery following Cervical Disc Fusion. For more information on the procedure or its potential benefits for your condition, you should discuss with a licensed expert in Spine Surgery.
Procedure Overview
Watch our educational video to learn more about this treatment, what to expect, and how it may help your condition.
Disc Replacement vs. Cervical Fusion
Multiple recent trials have directly compared CDR, sometimes called cervical disc arthroplasty ("arthro-" = joint, "-plasty" = reconstruction), with Anterior Cervical Discectomy and Fusion, the prior gold standard for treatment of cervical disc disease with neurologic dysfunction not responsive to conservative therapy (3-5). These studies have broadly shown comparable if not superior outcomes for CDR.
Pain and Mobility
All studies conducted thus far have demonstrated comparable results with regards to neck/arm pain and mobility, the two primary deficits associated with advanced cervical disc herniation (3-5). One study analyzing long-term outcomes over 20 years demonstrated that these benefits were persistent and remained comparable for both fusion and disc replacement, suggesting that CDR provides lasting benefits for appropriate patients consistent with current gold standard therapy (6).
Neurologic Outcomes
In prospective trials, neurologic outcomes, namely improvements in weakness or sensation issues caused by radiculopathy, have been equal or superior for CDR compared to ACDF (6). In one recent metanalysis of 25 studies comparing the two procedures, CDR was found to have better neurologic results compared to traditional fusion, suggesting that for patients with primary disability due to neurologic deficits, disc replacement may be the preferred option.
Motion Preservation
The most notable difference between fusion and cervical disc replacement comes with the preservation of segmental spinal motion (the ability for adjacent vertebrae to move with respect to one another, allowing for the spine to bend normally). CDR allows for preservation of segmental motion, whereas fusion, by definition, prevents segmental motion postoperatively (6). This key difference may allow patients undergoing CDR to have improved mobility in their neck following surgery compared to those undergoing surgery.
In addition to these major outcomes, patients undergoing CDR are less likely to require reoperation (3,5), less likely to develop disc disease in areas adjacent to the surgical site (7), and less likely to face swallowing difficulties following their surgeries (8). Nonetheless, adverse events following surgery between those undergoing ACDF and CDR are comparable, suggesting that the risk profiles of the two procedures are different and that appropriate procedure selection remains an important determinant of success.
Risks/Complications
The most common complications associated with CDR are as follows (9):
- Implant migration (23-25% of reported revisions)
- Persistent pain (15-16% of revisions)
- Device-related issues
- Heterotopic ossification* (the formation of bone around implanted devices)
*Notably, heterotopic ossification is quite common (occurring in greater than 50% of cases) and is not necessarily associated with worse outcomes, though abnormal bone formation can lead to new challenges in some cases
Expectations for Recovery
Recovery after CDR is usually (comparatively) rapid. Most patients are discharged the day after surgery (10) and are able to return to activities like driving and work after 12 and 14 days, respectively. On average, patients only require opioid painkillers for one week postoperatively, with 98% of patients undergoing CDR no longer using these medications 30 days after surgery (11). All neck surgeries are serious procedures, and each individual case is different. Nonetheless, recovery from CDR is often a smooth and fast process.
Recovery & Expected Results
Our specialists discuss what to expect during recovery, typical timelines, and the outcomes patients may experience.
Citations
- https://pubmed.ncbi.nlm.nih.gov/29325074/
- https://pubmed.ncbi.nlm.nih.gov/34538469/
- https://pubmed.ncbi.nlm.nih.gov/26537161/
- https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2782719?utm_source=openevidence&utm_medium=referral
- https://pubmed.ncbi.nlm.nih.gov/24010901/
- https://pubmed.ncbi.nlm.nih.gov/37644726/
- https://pubmed.ncbi.nlm.nih.gov/40882232/
- https://pubmed.ncbi.nlm.nih.gov/30062947/
- https://pubmed.ncbi.nlm.nih.gov/38819199/
- https://pubmed.ncbi.nlm.nih.gov/38709837/
- https://pubmed.ncbi.nlm.nih.gov/37728119/
Interested in This Treatment?
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Individual patient results vary. No outcome is guaranteed. This information is educational and not a substitute for professional medical advice.