Cervical disc replacement (arthroplasty)

In one minute

Cervical disc replacement, also called cervical disc arthroplasty or an artificial disc, removes a damaged neck disc through the front exactly as in ACDF, but instead of fusing the two vertebrae (the bones of the spine) it fits a small metal and plastic joint that keeps the level moving. It is for arm pain, numbness or weakness from a nerve root or spinal cord compressed by a disc at one or two levels, in a person with healthy bone and joints, after non-surgical care has failed. It needs general anaesthesia; a one-level operation commonly takes one to two hours, most patients are walking by the next day, and the hospital stay is similar to ACDF, from a single night to several days depending on the hospital. It is not endoscopic: an implant needs the open anterior approach.

What the operation is

The names are cervical disc arthroplasty (CDA), cervical total disc replacement (TDR) and artificial cervical disc. Several devices reached the market through Food and Drug Administration (FDA) investigational device exemption (IDE) trials, randomised comparisons against ACDF; a 2020 meta-analysis pooled 11 randomised trials across eight devices, nine of them FDA IDE trials and two from China, among them Prestige, ProDisc-C, Mobi-C and Bryan.

The discectomy is the same as in ACDF. Then, instead of a cage and plate, an implant with two metal endplates and a bearing between them is fitted to the disc space and anchored with small keels or teeth. The aim is to keep the level moving and so lower the load on the discs above and below; the review of the FDA trials reports lower adjacent-level stresses than after fusion.

Who it is for

The indications, as quoted from the North American Spine Society (NASS) coverage recommendations in a 2022 review, are radiculopathy from a disc herniation or spondylotic spur at one or two levels between C3 and C7 that has not responded to non-surgical treatment, or myelopathy from central stenosis at one or two of those levels, with or without neck pain; the review of the FDA trials names one- and two-level spondylosis or stenosis causing radiculopathy from C3 to C7. The candidate who suits it has a mobile neck, preserved disc height, healthy facet joints and good bone.

The same NASS list names who it is not for: infection, osteoporosis and osteopenia, instability, allergy to implant materials, severe spondylosis, severe facet joint arthropathy, ankylosing spondylitis, rheumatoid arthritis, previous fracture, ossification of the posterior longitudinal ligament (OPLL, a calcified ligament behind the vertebrae) and malignancy; other sources add stenosis and scoliosis. Compression behind the vertebral body, a kyphotic neck and disease at three or more levels point to ACDF or a corpectomy. Neck pain alone is not on that list.

For cervical myelopathy the evidence is thinner. A 2025 meta-analysis of 12 randomised trials found better overall success with arthroplasty and no difference in neurological success, dysphagia or adverse events, while calling the evidence relatively scant. It is considered for myelopathy only when the compression comes from the disc at one or two levels and the alignment and bone allow.

How it is done

The start is the same as ACDF: on your back under general anaesthesia, a short cut in a skin crease, the surgeon passing between the windpipe and gullet on one side and the carotid artery on the other, an X-ray confirming the level, and the disc, spurs and fragments removed under the microscope until the root and cord are free. The endplates are then prepared flat while keeping their hard outer bone, which protects against the implant sinking in. Trial implants find the size, the artificial disc is inserted centred on X-ray in two planes, its movement is checked, and the wound is closed with absorbable stitches. No plate is used.

How it compares with the endoscopic alternative

The endoscopic alternative is the posterior endoscopic cervical foraminotomy: it opens the nerve exit from the back through a 7 mm incision, removes the lateral fragment or spur, and leaves the disc untouched with nothing implanted. It is possible for one-sided arm pain from a soft herniation or spur in the foramen at one level, without myelopathy; the NASS guideline grades ACDF and posterior foraminotomy comparably successful for that lesion (grade B, which the guideline defines as fair evidence); it does not grade the foraminotomy against arthroplasty.

It is not possible when the disc compresses the cord or root centrally, when a collapsed disc space needs its height restored, when symptoms are on both sides, or when two levels are compressed from the front. Those patients need the anterior approach, and the question becomes fuse or replace. NASS grades the two comparable for short-term outcomes (grade B). The FDA trials, designed as noninferiority studies, found arthroplasty at least as good, with less surgery at neighbouring levels: 4.3% versus 10.8% at seven years for one-level operations and 5.1% versus 10.0% for two-level ones in the 2020 pooled analysis of 11 trials.

Risks and how we reduce them

The approach shares the risks of ACDF: temporary difficulty swallowing, hoarseness, haematoma, infection, spinal fluid leak and injury to a nerve root or the cord; the pooled rates are on the ACDF page. The implant adds its own. Heterotopic ossification, new bone forming around the implant, is common: in the two-level Prestige LP trial 39% of patients had severe (grade III or IV) ossification at ten years, and grade IV (bridging bone that stops movement at that level) was seen at 8.2% of upper and 10.3% of lower levels. Severe ossification did not increase significantly between seven and ten years in that series, and the group's average movement at the treated levels was maintained. Subsidence, migration, wear and spontaneous fusion are also reported; any implant can need removal and conversion to fusion.

Against fusion, the trial data run the other way. At ten years the two-level Prestige LP group had fewer serious implant- or procedure-related adverse events (3.8% versus 8.1%) and fewer secondary operations at the treated (4.7% versus 17.6%) and adjacent levels (9.0% versus 17.9%). The seven-year Mobi-C trial reported adjacent-level surgery in 3.7% of one-level arthroplasty patients versus 13.6% after ACDF; the seven-year ProDisc-C trial reported secondary procedures in 7% versus 18%. The Prestige LP and Mobi-C papers state that their trials were sponsored by the implant makers, Medtronic and Zimmer Biomet; read the results with that in mind.

Surgeons reduce these risks by strict selection: a bone density scan when osteoporosis is possible, CT (computed tomography) of the facet joints, flexion-extension X-rays for instability, and careful sizing and placement centred on X-ray. Across all the team's operations our complication figure is well below 1%; that is our own figure and not a comparison with anyone else.

Recovery, week by week

What the evidence says

The review of the FDA IDE trials (2020) concludes that early and long-term results establish arthroplasty as an alternative to fusion for one- and two-level radiculopathy, while calling the adjacent-segment data suggestive rather than settled. The 2020 meta-analysis of 11 randomised trials found adjacent-level surgery roughly halved at seven years. Gornet 2019 reports ten-year overall success of 80.4% for two-level Prestige LP versus 62.2% for ACDF; Radcliff 2017 (Mobi-C) and Janssen 2015 (ProDisc-C) report seven-year results in the same direction. The 2025 myelopathy meta-analysis favoured arthroplasty but rated the evidence thin.

How we do it at spine.uz

We are Tashkent's first endoscopic spine team, five surgeons operating as one, with 27,600+ endoscopic and spine operations in total. Cervical pages are reviewed by Dr. Akhror Yakubov, neurosurgeon. We operate on all levels, including multilevel cervical cases.

The first step is free: send your MRI (magnetic resonance imaging) on Telegram or WhatsApp and a doctor from the team replies by voice within 48 hours, saying whether a posterior endoscopic foraminotomy would solve the problem and, if the front approach is needed, whether the MRI, CT and bone density fit the trial criteria for a disc replacement or point to ACDF. After the operation you receive a written conclusion and the team follows you up on Telegram.

Preparing for the operation

Photograph every slice of your cervical MRI, plus any CT or X-ray, and send it ahead. If you are past the menopause, have taken steroids or have other risk factors for osteoporosis, expect a bone density scan before the decision, since osteoporosis and osteopenia are on the list of contraindications. Bring your list of medicines; tell us about blood thinners and anti-inflammatory drugs, and the surgeon decides when to pause them. Stop smoking. Fast as the anaesthetist instructs and arrange someone to accompany you home.