Cervical anterior discectomy and artificial disc replacement

What is This Treatment?

Cervical anterior discectomy and artificial disc replacement involves removal of a diseased disc compressing the nerve root or spinal cord in the cervical spine through an anterior cervical approach and placement of a mobile artificial disc in its place. While fusion is aimed at the disc level in classical ACDF surgery, the goal with disc arthroplasty is to preserve motion at that level as much as possible. For this reason, it is evaluated particularly in selected patients with single-level cervical hernia who are younger, lead an active lifestyle, and do not have advanced facet joint degeneration. Not all cervical hernia patients are suitable candidates; surgical decisions must consider the patient's age, disc height, bone quality, spinal alignment, and accompanying degenerative changes together.

Benefits

• Can help relieve pressure on the nerve or spinal cord while preserving motion at the same level
• Has the potential to reduce biomechanical load on adjacent segments in selected patients
• Can provide high rates of clinical relief for symptoms such as neck and arm pain, numbness, and weakness
• Since fusion is not expected, neck motion and rehabilitation can be planned more comfortably in some patients

Treatment Process

Preoperatively, cervical MRI, and if necessary CT and dynamic imaging clarify which level is problematic. The procedure is performed under general anesthesia through a small incision on the front of the neck. First, the diseased disc is removed and pressure on the nerve root and spinal cord is carefully relieved. The end plates are then appropriately prepared, measurements are taken to select the appropriate prosthesis, and it is placed under fluoroscopic guidance. The goal is not only to clean the hernia but also to preserve segment height and controlled motion. After the procedure, the patient is closely monitored for swallowing, voice changes, neurological examination, and early mobilization.

When is it used?

• Selected patients with arm pain, numbness, or weakness due to single-level cervical disc herniation
• Cases with nerve root compression that is concordant with imaging and does not improve despite conservative treatment
• Young and active patients where a motion-preserving solution is deemed appropriate as an alternative to fusion
• Patients without advanced facet joint degeneration, preserved spinal alignment, and adequate bone quality

Recovery and planning

Hospital stay after cervical disc arthroplasty is usually 1-2 days. In the first few days, throat tenderness, difficulty swallowing, or neck stiffness may be observed; these are usually temporary. Early relief is expected in arm pain and radicular symptoms, but improvement of numbness and weakness may take longer. Transition to neck motion may be earlier in some patients compared to fusion surgery; however, sudden neck movements and heavy lifting should be avoided in the first weeks. Return to desk work is possible in most patients within a few weeks, while more intensive physical activities are planned after controlled examination. Correct patient selection is as decisive as the technique itself for this surgery's success.