Cervical Arthroplasty (Artificial Disc Replacement)

The surgical approach for cervical disc replacement is similar to anterior cervical discectomy and fusion (ACDF).

A small incision is made in the front of the neck, and the cervical spine is reached by gently moving the trachea, esophagus, and surrounding soft tissues aside. The damaged disc is completely removed, and the vertebral end plates are carefully prepared to receive the artificial disc.

The artificial disc is then positioned precisely between the two vertebrae. Most modern implants consist of two metal end plates (typically titanium or cobalt-chromium alloy) with a polyethylene or metal core that allows controlled flexion, extension, rotation, and side bending. Over time, bone grows onto the implant’s surface, helping secure it in place. Unlike ACDF, no bone graft, fusion, or anterior plate is typically required.

What makes cervical disc replacement different from ACDF

Both cervical disc replacement and ACDF relieve pressure on the spinal cord or nerve roots by removing the damaged disc. The key difference is what replaces it.

ACDF: The disc space is filled with a bone graft or cage, and the goal is for the two vertebrae to fuse into a single solid bone, permanently eliminating motion at that level.

Cervical disc replacement: An artificial disc replaces the damaged disc while preserving motion at the treated level.

Potential advantages of motion preservation include:

• Preserves natural motion: The treated spinal level continues to move rather than becoming permanently fused.
• Reduced mechanical stress on adjacent levels: Preserving motion may reduce the additional forces placed on the discs above and below the treated level.
• Lower rates of adjacent-level surgery: Multiple randomized clinical trials with long-term follow-up have shown lower rates of additional surgery at adjacent levels in appropriately selected patients compared with ACDF.

Not every patient with cervical disc disease is a candidate for cervical disc replacement. Ideal candidates typically have:

• Single- or two-level symptomatic disc disease causing cervical radiculopathy or mild cervical myelopathy
• Disc herniation or degenerative disc disease confirmed on MRI
• Persistent symptoms despite at least 6 weeks of appropriate conservative treatment
• Neutral or near-normal cervical alignment
• Good bone quality to support long-term implant fixation

Cervical disc replacement is generally not recommended for patients with:

• Significant cervical instability or deformity
• Severe facet joint arthritis at the affected level
• Significant osteoporosis or poor bone quality
• Three or more symptomatic levels requiring treatment
• Prior cervical fusion that would compromise implant function in selected cases

Your spine surgeon will carefully evaluate your symptoms, imaging, spinal alignment, bone quality, and facet joints to determine whether cervical disc replacement, ACDF, or another procedure is the most appropriate treatment for your condition.

Several FDA-approved cervical disc replacement devices are in clinical use. Common implant designs include:

• Metal-on-polyethylene — cobalt-chrome end plates with a high-density polyethylene core. Widely used, long clinical track record.
• Metal-on-metal — all-metal design that allows a slightly different kinematic profile.
• Titanium shell designs — porous titanium coating on end plates promotes bone ingrowth and long-term fixation.

Your surgeon will select the implant design best suited to your anatomy, the disc space dimensions measured on your imaging, and their own clinical experience with specific devices.