Living with neck pain can be challenging, and it can affect our daily lives and activities. Around 15% of adults in the United States experience neck pain at some point over the past 3 months. When conservative treatments don’t provide relief, two surgical interventions often emerge as leading options — cervical artificial disc replacement (ADR) and cervical fusion.
It’s important to understand these surgery options and the nuances in each approach before settling on one. Learn the differences between cervical ADR, their advantages and disadvantages and patient factors to help you determine the best approach for your needs.
Cervical spine fusion, known medically as anterior cervical discectomy and fusion (ACDF), is a standard surgery to address cervical spine conditions. One of the most established cervical procedures, it involves permanently joining two or more vertebrae in the neck. The goal is to stop movement at the segment to alleviate pain and neurological symptoms.
Cervical fusion has been shown to be highly effective in addressing conditions like advanced degenerative disc disease and osteoarthritis. Both conditions can benefit from fusion since they often cause spinal compression or instability.
Disc fusion cervical spine surgery is performed under general anesthesia. It starts with an incision at the front of the neck to remove the damaged or diseased cervical disc. This relieves pressure on the spinal cord and nerve roots. Once removed, the space between the vertebrae is then bridged with a bone graft, either from the patient’s own body or a donor synthetic substitute. Surgeons then typically use a small metal plate and screws to stabilize the vertebrae and hold the bone graft in place.
As the body naturally heals over the next several months, it encourages the bone graft and adjacent vertebrae to grow together to form a single, solid unit.
Cervical ADR spinal surgery is a modern surgical option that can address similar cervical issues as fusion. The critical difference is that cervical ADR preserves motion at the treated segment. The procedure involves removing the damaged disc and inserting a mobile prosthetic device in its place, instead of a bone graft. This artificial disc is meant to replicate the natural disc’s function, allowing continued movement.
This new surgery shows promise, with more spine surgeons adopting the procedure to help patients alleviate symptoms while also restoring their movement.
Artificial discs are made from metal endplates that attach to the vertebrae and a central core, often made from polyethylene or a similar material, which allows for movement. This lets the implant absorb shock and act like a pivot point, mimicking the natural movement of the intervertebral disc. Cervical ADR is often used to address conditions like degenerative disc disease, herniated discs and spinal stenosis.
Both cervical fusion and cervical ADR can relieve chronic pain and neurological symptoms, but they do so in different ways and offer different advantages.
Both procedures have been shown to be effective. One study that followed patients for 10 years found a low risk of reoperation for ADR, with only 7.2% of patients requiring another surgery, compared to 25.5% of fusion patients.
Further, surgeries specifically for adjacent segment disease were only 3.1% in the ADR group compared to 20.5% in the fusion group.
Patients who undergo ADR can often return to work and activities faster than those who undergo fusion. Since there’s no need to wait for the bone to fuse, recovery can be shorter with fewer restrictions on activities. Fusion, in contrast, often requires several months of no activity to let the bone heal and fuse.
While both procedures can be effective, they come with potential limitations that you’ll need to weigh carefully.
The most significant limitation of cervical fusion is the permanent loss of motion at the treated level. This can make the neck feel stiff, especially if the surgery involved multiple fusions. Some patients may find the longer recovery period from bone healing and activity restrictions a disadvantage.
In contrast, cervical ADR isn’t suitable for all patients. It is contraindicated in cases of severe degeneration, spinal instability and significant osteoporosis. These conditions can compromise the stability of the implant. Patients must have an amenable anatomy to the artificial disc.
Adjacent segment disease (ASD) is a concern with spinal fusion. It refers to the wear and tear on discs and facet joints immediately below the fused segment, since they’re subjected to more stress once the fused segment is immobile. This can accelerate their degeneration, leading to new symptoms and further surgery. ADR can mitigate this risk by preserving motion, thereby reducing stress on the discs and facet joints.
For ADR, the procedure can be technically demanding, and its success largely depends on the surgeon’s experience and expertise. This makes it crucial to choose an experienced surgeon for the best outcomes. The precise placement and sizing of the artificial disc are crucial to preserving motion and function.
The choice between cervical ADR and cervical fusion is highly individualized, depending on a variety of patient-specific factors.
Choosing between cervical ADR and cervical fusion is a major decision. You deserve complete confidence in your treatment plan. Let the Desert Institute for Spine Care (DISC) be your compassionate partner in your healthcare journey. We remain committed to providing minimally invasive care, tailored to your lifestyle, and to help alleviate your pain. Our surgical specialists use cutting-edge techniques and take a personalized approach to each patient’s care.
We can provide the expert guidance you need to make an informed decision about your spinal health. Schedule a consultation today to discuss your needs and concerns and explore the best path forward.
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