Cervical Disc Replacement (Arthroplasty)
Cervical disc replacement is particularly suited to younger, active patients with single-level disc herniation causing radiculopathy or myelopathy.
Overview
What is Cervical Disc Replacement?
Cervical disc replacement — also called cervical disc arthroplasty — is a surgical procedure that replaces a damaged or degenerate cervical intervertebral disc with an artificial disc implant designed to preserve normal motion at the treated level. Like ACDF, the damaged disc is removed through a small anterior (front of neck) incision to decompress the nerve roots and spinal cord. However, instead of fusing the two adjacent vertebrae together, a motion-preserving artificial disc is inserted in place of the removed disc.
The primary advantages of disc replacement over fusion (ACDF) are the preservation of neck motion and the theoretical reduction in adjacent segment disease — the accelerated degeneration that can occur at levels above or below a fused segment. Cervical disc replacement is particularly suited to younger, active patients with single-level disc herniation causing radiculopathy or myelopathy.
At One Brain and Spine, our Melbourne neurosurgeons are experienced in both cervical disc replacement and ACDF and will recommend the most appropriate procedure based on each patient's disc anatomy, degree of degeneration, age, and clinical presentation.
Cervical Disc Replacement vs ACDF — Which is Better?
Both procedures achieve excellent nerve decompression through the same anterior approach. The key difference is what happens to the treated level after disc removal:
- ACDF — treated level is permanently fused; eliminates motion at that segment; gold standard with decades of evidence
- Cervical disc replacement — treated level preserves motion; may reduce adjacent segment degeneration; backed by strong 10–15-year evidence for appropriate patients
Cervical disc replacement is most appropriate for patients with single-level cervical disc herniation; good bone quality; no significant facet joint arthritis at the treated level; and no cervical instability. It is generally not appropriate for patients with severe multilevel degeneration, facet joint arthritis, ossification of the posterior longitudinal ligament (OPLL), or cervical deformity.
Procedure
Preoperative Preparation
The surgical approach is identical to ACDF. MRI confirms the level and suitability for disc replacement. CT and CT SPECT bone scan may be used to assess bone quality and facet joint degeneration. Blood thinners are ceased before surgery.
What Happens During Cervical Disc Replacement?
The procedure is performed under general anaesthesia via the same anterior approach as ACDF — a 3-to-4-centimetre incision in the natural skin crease of the neck. The damaged disc is completely removed, and the neural elements are decompressed. The disc space is precisely sized using trial implants, and the artificial disc prosthesis — a low-profile device with metal endplates and a mobile or semi-constrained articulating core — is carefully seated in the disc space. X-ray imaging confirms correct position and sizing.
No plate is required. The wound is closed with dissolvable sutures. The procedure takes approximately 60 to 90 minutes for a single level.
Types of Artificial Disc Implants
Several FDA- and TGA-approved artificial disc designs are available. Each has slightly different design characteristics — your surgeon will select the most appropriate implant based on disc space geometry and individual anatomy.
Hospital Stay
One to three days, similar to ACDF. A routine postoperative X-ray confirms implant position. Postoperative management is essentially the same as ACDF.
Recovery
Recovery from cervical disc replacement is very similar to ACDF. The anterior approach is the same and postoperative symptoms — sore throat, swallowing discomfort, and incisional neck pain — are identical.
Activity Guidelines
- Walking — from the day of surgery
- Lifting — maximum 5 kilograms for four weeks
- Driving — typically after one to two weeks
- Swimming and hydrotherapy — from two weeks
- Physiotherapy — commences at four-week postoperative review
- Running — cleared at approximately two months; contact sports avoided for three months
Cervical Collar
Not routinely required. Motion at the replaced level is encouraged.
Return to Work
Office and sedentary work: two to four weeks. Physical or manual work: four to six weeks or longer depending on activities required.
Follow-Up Imaging
An X-ray twelve weeks confirm implant position and motion at the replaced level. The disc replacement should show preserved motion on flexion-extension X-rays.
Outcomes & risks
Cervical disc replacement achieves equivalent relief of arm pain and radiculopathy to ACDF in over 90% of patients. Long-term follow-up studies (7–17 years) demonstrate sustained clinical outcomes, lower rates of adjacent segment disease, and lower rates of reoperation compared to ACDF in appropriately selected patients. Preservation of cervical motion is demonstrated on follow-up flexion-extension X-rays in the majority of patients.
Risks and Complications
Shared with ACDF
- Sore throat and dysphagia (difficulty swallowing) — very common; usually resolves within weeks
- Voice change — approximately 1% permanent
- Wound infection — approximately 1%
- Nerve or spinal cord injury — rare
Disc Replacement-Specific Risks
- Implant malposition or subsidence — rare with careful surgical technique
- Heterotopic ossification — new bone forming around the prosthesis, reducing motion; occurs in a proportion of patients, mostly without clinical significance
- Device failure or wear — very rare with modern implant materials
- Conversion to fusion — required in a small number of patients due to persistent pain, malposition, or implant failure
Alternatives
ACDF remains the gold standard alternative and is appropriate for patients not suitable for disc replacement. Conservative management including physiotherapy and cervical injections is always trialled first for radiculopathy without myelopathy.
Frequently Asked Questions — Cervical Disc Replacement Melbourne
Am I a candidate for cervical disc replacement?
Ideal candidates have single-level cervical disc herniation causing arm pain or radiculopathy, good bone quality, preserved non arthritic facet joints at the treated level, and no cervical instability. Multi-level disease, significant facet arthritis, OPLL, or deformity generally favour ACDF. Your neurosurgeon at One Brain and Spine will advise based on your specific MRI and clinical findings.
Does cervical disc replacement last long-term?
Long-term studies extending to 17 years demonstrate sustained clinical benefit and preserved motion in the majority of patients. Cervical disc replacement is a well-established procedure with a strong long-term evidence base.
Will my neck still move after disc replacement?
Yes — preserving motion at the treated level is the primary objective of disc replacement. Follow-up flexion-extension X-rays typically demonstrate maintained range of motion at the replaced level in most patients.
Is the surgery different from ACDF?
The approach and disc removal are identical. The key difference is what is placed after disc removal — an artificial motion-preserving disc rather than a fusion cage and plate. Operating time is similar, and recovery is essentially the same.
Why Choose One Brain and Spine?
One Brain and Spine is a specialist neurosurgical group practice in Melbourne, with subspecialty expertise in minimally invasive and endoscopic spine surgery. We provide expert, evidence-based care with a strong focus on patient safety and optimal recovery.
- Specialist neurosurgeons — with extensive spine surgery experience
- Minimally invasive and endoscopic techniques — smaller incisions, less disruption, faster recovery
- Intraoperative navigation and neuromonitoring — precision and safety
- Comprehensive pre- and postoperative care — personalised to each patient
- All major health funds accepted