Total Disc Replacement versus Anterior Cervical Discectomy and Fusion

At TMI Sports Medicine and Orthopedic Surgery we treat at variety of spine conditions. Those conditions range from the sports-related spine injury, to scoliosis, to major spine reconstruction surgery. We are on the cutting edge of technology and evidence-based medicine.

Approximately 50% of the spine patients we see have issues relating to their neck. These issues can be related to neck sprain/strains, which are commonly treated with physical therapy and/or medications. But some patients present with neck, arm, chest and periscapular pain that is usually associated with cervical radiculopathy. Cervical radiculopathy is a condition where there is a compressing of the cervical spinal cord or nerve roots which is caused by a herniated disc or bone spur. This causes nerve pain that will present as neck, arm, chest, and periscapular pain, numbness, or tingling.

Cervical radiculopathy can be treated conservatively most of the time with physical therapy and will likely include traction therapy, medications, and sometimes epidural steroid injections. However, patients who fail these conservative treatments and continue to have consistent symptoms sometimes progress to surgical interventions.

Historically, cervical radiculopathy has been surgically treated with an anterior cervical discectomy and fusion (ACDF, or “fusion”). This approach has been used for over 70 years to treat cervical radiculopathy and is still the major workhorse to treat cervical radiculopathy. It is also the only way to treat multilevel disease where there is more than one or two cervical discs that are creating a problem. An ACDF consists of taking the cervical disc or bone spur off the spinal cord or nerve root to alleviate the pressure on that structure. However, you must replace the disc, and in the case of an ACDF, you replace the disc with bone either from a cadaver or from the patient’s iliac crest bone also known as a hip graft.

To see an example of this type of procedure please click on the following link and scroll down and click on the video labeled “Anterior Cervical Discectomy with Fusion”.

There is now another option instead of an ACDF. It is called the Total Disc Replacement. It was first introduced in Europe almost 20 year ago. It has been approved in the United States since 2006. The total disc replacement is an implant that is used to replace the disc space instead of bony fusion. It allows for a greater range of motion post-operatively than a fusion, and data shows that it creates less wear and tear on the adjacent cervical discs. Whereas in an ACDF/ fusion the know rate of reoperation ten years after a cervical fusion is 20%, the rates with total disc replacement is currently around 5%.

To see an example of a cervical total disc replacement please click on the following link and scroll down and click on the video labeled “Artificial Cervical Disc Replacement”.

At TMI Sports Medicine and Orthopedic Surgery we are at the cutting edge of spinal technology and use evidence-based medicine to make decisions in the best interest of our patients. For more information about our services please visit our main spine site at the link below.