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Cervical Disc Arthroplasty (Cervical Disc Replacement)

Motion-preserving alternative to anterior cervical discectomy and fusion (ACDF) using artificial disc to maintain segmental mobility, reduce adjacent segment degeneration, and treat cervical radiculopathy and myelopathy.

Written by: Saygı Hospital Health Guide Editorial Board
Published:

This content is for general information; please consult your physician for diagnosis and treatment.

References (5)

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What is Cervical Disc Arthroplasty (Cervical Disc Replacement)?

Cervical disc disease pathophysiology: progressive disc dehydration, height loss, herniation, osteophyte formation, and facet hypertrophy can compress nerve roots (radiculopathy) or spinal cord (myelopathy). Surgical treatment is indicated when conservative management fails (6-12 weeks) and persistent neurologic symptoms or progressive deficit present.

ACDF — historical gold standard: anterior approach, complete disc excision, structural graft (autograft, allograft, cage with bone graft) and plate fixation, achieving fusion. Drawback: adjacent segment disease (ASD) — accelerated degeneration at adjacent levels with reported rates 2-3% per year, ~25% requiring revision over 10 years.

CDA rationale: by preserving motion at the surgical level, theoretically reduce stress and degeneration at adjacent levels. Various artificial disc designs offer different bearing surfaces, range of motion, and constraint levels. Indications must be carefully selected for optimal outcomes.

Symptoms

Cervical radiculopathy (radiating arm pain, numbness, weakness in nerve root distribution)
Cervical myelopathy (gait dysfunction, fine motor difficulty, hyperreflexia, bowel/bladder dysfunction in severe)
Persistent symptoms despite 6-12 weeks of conservative management
MRI evidence of disc herniation, foraminal stenosis, or central canal stenosis at one or two levels
Failed conservative treatment: NSAIDs, physical therapy, epidural steroid injections
Progressive neurologic deficit
Functional limitation interfering with work/activity

Risk Factors

Age 18-65 years (younger more ideal candidates)
Single-level or two-level disease (most devices approved for one or two-level)
No significant facet arthropathy
Adequate bone quality (not osteoporotic)
Adequate disc height (>3 mm)
Adequate sagittal alignment (kyphosis at index level relative contraindication)
No significant ossification of posterior longitudinal ligament (OPLL)
No segmental instability

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent cervical radiculopathy or myelopathy after conservative care
  • Progressive neurologic deficit
  • Severe arm pain affecting function and sleep
  • Cord compression on MRI
  • Spine surgery referral for treatment options discussion (CDA vs ACDF vs posterior approaches)

Treatment Methods

01
Patient selection — ideal CDA candidate: age 18-65, single or two-level cervical disc disease (C3-C4 to C6-C7), radiculopathy or myelopathy from soft disc herniation or foraminal/central stenosis, failed conservative therapy, intact facet joints, adequate bone quality, neutral or lordotic sagittal alignment, no instability or significant deformity
02
Contraindications: severe facet arthropathy, segmental kyphosis or instability, ossification of posterior longitudinal ligament, significant osteoporosis, infection, malignancy, multiple-level disease >3 levels, ankylosing spondylitis or DISH, prior fusion at adjacent level (relative)
03
Pre-operative imaging: standing AP and lateral cervical X-rays, flexion-extension views, MRI for disc herniation/cord compression, CT for bony anatomy and OPLL, DEXA if osteoporosis concern
04
Surgical approach: standard anterior cervical approach (Smith-Robinson) — left or right side based on surgeon preference and laryngeal nerve considerations; complete disc excision, posterior longitudinal ligament resection if needed, decompression of nerve roots and cord, endplate preparation
05
Implant placement: appropriate sizing (height, footprint, depth), centered placement on midline, parallel to endplates, biomechanical testing of stability, fluoroscopic confirmation
06
Postoperative protocol: hard or soft cervical collar (variable, often 1-2 weeks), early mobilization, gradual return to activity, no NSAIDs initially (to allow bony ingrowth — depends on device), follow-up X-rays at 6 weeks, 3, 6, 12 months
07
Outcomes vs ACDF: meta-analyses show similar or superior outcomes for CDA in radiculopathy at 7-10 years; lower rate of adjacent segment surgery (4-7% vs 10-15% at 7 years); maintained motion (~7-10° at index level); slightly higher device-related complications
08
Complications specific to CDA: heterotopic ossification (10-30%), device migration or subsidence (1-3%), implant wear, polyethylene debris reaction, secondary surgery for ossification or device issues, dysphagia, dysphonia (common to all anterior approaches)
09
Two-level CDA: FDA-approved for several devices; outcomes similar to single-level in selected patients; some devices approved hybrid construct (CDA + ACDF at adjacent level)
10
Hybrid construct: CDA at one level + ACDF at adjacent level — useful when one level has severe degeneration not amenable to motion preservation; outcomes acceptable
11
Long-term outcomes: 10+ year follow-up showing durability of devices, sustained clinical benefit, lower adjacent segment surgery rates compared to ACDF; ongoing surveillance for late complications (heterotopic ossification, wear)
12
Patient counseling: discuss CDA vs ACDF differences, motion preservation rationale, longer-term unknown beyond 10-15 years for some devices, importance of early mobilization vs initial restriction, expected outcomes and recovery timeline
13
Cost-effectiveness: CDA initially more expensive than ACDF but reduced adjacent segment surgery may favor cost-effectiveness over decades; varies by health system

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.