Author - Jeffrey A. Goldstein, MD, FACS

Anterior Cervical Discectomy and Fusion vs Anterior Cervical Disc Replacement -  A Comparison

A common question from patients is "Which procedure is better?" The answer is "it depends," and what's best for one patient may be different for another. Expert diagnosis by, and discussion with an experienced spine surgeon is critical. This article will guide you through some of the considerations.

The human spine is complex.   The structure provides both mobility and strength. Proper functioning of the neck, also known as the cervical spine, is important for overall spinal health. The cervical spine contains seven small vertebrae and supports the weight of the head. The cervical spine has the greatest range of motion, partly because of upper two specialized vertebrae which move with the skull. This flexibility, however, makes the neck more susceptible to injury and conditions that cause pain and restrict motion. Maintaining a healthy cervical spine is essential for a patient’s well-being.

When conservative non operative treatments such as physical therapy, medications, or spinal injections fail to relieve neck pain caused by degenerative disc disease, herniated discs, or stenosis, surgical intervention may be considered. Two common procedures are Anterior Cervical Discectomy and Fusion (ACDF) and Anterior Cervical Disc Replacement (ADR). Both procedures aim to relieve pain, but they do so in slightly different ways and with different long-term implications.

ACDF is a time-tested surgical treatment for symptomatic cervical disc disease. During ACDF, the surgeon removes the problematic disc entirely and replaces it with a bone graft or a bone graft substitute. This is often supplemented with an interbody cage and possibly a plate with screws. The primary goal of the procedure is to relieve pain caused by nerve compression by removing the disc material and providing space for the nerve roots.

The secondary goal is to allow the adjacent vertebrae to fuse together over time, which provides stability.

ACDF has been performed for decades, and its effectiveness and safety profile are well-known. It is commonly used to treat symptoms related to degenerative or herniated discs in the neck. ACDF can treat people who have had previous neck surgery, damaged vertebral bones, and facet joint degeneration. ACDF may be less complicated than ADR since there is no need to size and place an artificial disc as precisely. Many patients can return to office work and light activity within days to weeks, with full fusion typically occurring in about three months. Return to work may be similar to cervical disc replacement.

However, one potential downside of Anterior Cervical Discectomy and Fusion  is that it can lead to reduced range of motion in the neck and increased stress on the discs above and below the fused vertebrae. This can potentially lead to further disc degeneration and the need for additional surgeries in the future.

On the other hand, Anterior Cervical Disc Replacement   is a newer surgical procedure that also involves removing the problematic disc.  But instead of fusing the vertebrae, an artificial disc is inserted to maintain motion between the vertebrae. The goal of ADR is similarly to relieve symptoms of cervical disc disease while maintaining more normal neck motion, and potentially reducing the risk of degeneration in adjacent discs.

Dr. Jeffrey A. Goldstein, an orthopedist in New York, New York, and affiliated with NYU Langone Hospitals1, has been in practice for more than 20 years. He has expertise in treating spinal fusion, neck pain, and spine problems1. Dr. Goldstein was a lead investigator and participated in the FDA trials proving the benefits of cervical artificial disc replacement2. His proficiency in robotic spine surgery, artificial disc replacement, and minimally invasive surgery has earned him recognition both nationally and internationally.

Some studies suggest that cervical ADR maintains more natural biomechanics within the cervical spine and places less stress on discs above and below the surgical level compared to ACDF. While favorable clinical outcomes have been observed for both ACDF and ADR, longer-term results for cervical artificial discs are still being studied. Patients can return to work and light activity within two to four weeks after cervical disc replacement.

In summary, ACDF and ADR are both effective surgical treatments for cervical disc disease. ACDF is a tried-and-true procedure with a long history of good outcomes.  Cervical ADR is a newer procedure that aims to preserve range of motion. However, not everyone is a candidate for ADR, and the long-term effectiveness and safety of artificial discs are still being studied.

The choice between ACDF and ADR depends on many factors, including the patient’s unique situation and condition, the specific nature of the disc disease, the presence of other conditions such as osteoporosis or arthritis, and the surgeon’s expertise. Both procedures have their merits and can significantly improve quality of life for patients with cervical disc disease. Dr. Goldstein can help you to determine the best approach for your specific needs. Ultimately, the goal of either procedure is to help patients return to their normal activities and enjoy a higher quality of life with less pain.