Marc Darrow MD,JD

There are many options in helping people with neck pain or degenerative disease in their cervical spine. At our clinic we try to help as many people avoid surgery as we can although for some people surgery will be their only realistic option and we advise these people appropriately. Sometimes a person may think they need surgery because they have been told that the must have it even though the evidence for their needing a surgery may be based solely on an interpretation of an MRI. As researchers have pointed out most people will not need a neck surgery. In this article we will exam research from surgeons in providing information on surgery or no surgery and whether an artificial cervical disc replacement  or Anterior cervical discectomy and fusion (ACDF) may be the surgery worth exploring further.

There are many different types of neck or cervical spine surgery. Most surgeries are recommended because a disc or multiple discs are being squeezed or flattened out and this is causing compression on the nerves that travel through the neck vertebrae. A neck pain sufferer may get a cervical discectomy or microdiscectomy which removes the disc pressing on the nerves. When this surgery fails, the patient may be recommended for a more aggressive surgery or no surgery at all.

There are many different types of neck or cervical spine surgery for cervical spondylosis

Artificial cervical disc replacement is an alternative to ACDF designed to preserve the neck and head range of motion and ROM and reduce adjacent segment disease.

Artificial cervical disc replacement was designed to alleviate the same problems that a fusion surgery was designed to do. That is to relive symptoms of nerve compression in the neck. Sufferers will recognize these symptoms as chronic neck pain, pain and numbness that may extend into the shoulders, arms, and hands. In severe cases requiring surgery, these symptoms may include walking difficulties, trouble with motor coordination, and loss of bladder or bowel control.

The artificial disc, as opposed to the fusion surgery, helps maintain a more normal range of motion. However, if bone spurs and advanced osteoarthritis is present, the artificial disc will not improve on the patient’s neck range of motion already present. A greater benefit may be that the artificial disc replacement surgery will prevent adjacent segment disease from occurring. Adjacent segment disease is the rapid degeneration of the cervical spine segments next to the fused area. If you have c4-C5 fusion the adjacent segments would be C3-C6.

Recovering from cervical fusion surgery

Let’s have the surgeons discuss this further. A July 2022 paper (1) “Anterior cervical discectomy and fusion (ACDF) surgery is commonly performed to treat cervical degenerative disc disease. The loss of range of motion is also found after Anterior cervical discectomy and fusion, which contributes to degenerate in adjacent segment disease (ASD). Artificial cervical disc replacement (ACDR), an alternative to ACDF, is developed to preserve the ROM and reduce ASD. Prolonged operative duration, better overall success, neurological success, and NDI (a Neck Disability index score) success rates were found in Artificial cervical disc replacement group in all follow-up periods, with lower dysphagia/dysphonia during short-term follow-up. Moreover, a lower adjacent segment disease was found in Artificial cervical disc replacement group during long-term follow-up and overall analysis, with lower reoperation rates in all follow-up periods.”

A June 2020 paper (2) compared the efficacy and safety of the postoperative long-term effect of the treatment of single-level cervical spondylosis through anterior cervical discectomy and fusion (ACDF) and artificial cervical disc replacement (ACDR).

  • A total of 113 patients were divided into two groups depending on the operation method and these patients receive more than 96 months of follow-up. The pain scores and Neck Disability index score of these two groups of patients significantly improved, when compared with those before the operation.
    • In the last follow-up visit, six patients (12.77%) in the ACDR group and 18 patients (27.27%) in the ACDF suffered from adjacent segment degeneration (ASD). The general complication rate in the replacement group and fusion group was 38.31% and 37.88%, respectively, but the difference between the two groups was not statistically significant. Overall, the clinical efficacy and related complication rate of single-level cervical spondylosis after an anterior cervical approach operation was superior in the ACDR group when compared to the ACDF group.

Artificial cervical disc replacement

A November 2021 study (3) Heterotopic ossification (abnormal growth bone in muscle and soft tissue) is a common complication after cervical disc replacement. Biomechanical factors including endplate damage resulting in loss of bone coverage and intervertebral disc height change may be related to Heterotopic ossification formation. Patients who underwent single-level or two-level cervical disc replacement are at risk for endplate damage and intervertebral disc height change.

The phenomenon of anterior bone loss is unique to cervical disc arthroplasty and has only recently gained notice

A July 2022 paper (4) Although cervical disc arthroplasty has reportedly been associated with similarly low incidences of complications to anterior cervical discectomy and fusion, the phenomenon of anterior bone loss is unique to cervical disc arthroplasty and has only recently gained notice.  During the average follow-up of 2 years (in patients in this study undergoing cervical disc arthroplasty, anterior bone loss was a common radiologic finding. More than half of the patients (26 of 41 in this study, 63.4%) in the series gained cervical lordosis after cervical disc arthroplasty. These patients with increased cervical lordosis after cervical disc arthroplasty had higher grades of anterior bone loss.

 

1 Peng Z, Hong Y, Meng Y, Liu H. A meta-analysis comparing the short-and mid-to long-term outcomes of artificial cervical disc replacement (ACDR) with anterior cervical discectomy and fusion (ACDF) for the treatment of cervical degenerative disc disease. International Orthopaedics. 2022 Feb 3:1-7.
2 Guo H, Sheng J, Sheng WB, Liang WD, Wang J, Xun CH. An eight‐year follow‐up study on the treatment of single‐level cervical spondylosis through intervertebral disc replacement and anterior cervical decompression and fusion. Orthopaedic Surgery. 2020 Jun;12(3):717-26.
3 Shen YW, Yang Y, Liu H, Rong X, Ding C, Meng Y, Wang BY, Hong Y. EFFECTS OF ENDPLATE COVERAGE AND INTERVERTEBRAL HEIGHT CHANGE ON HETEROTOPIC OSSIFICATION FOLLOWING CERVICAL DISC REPLACEMENT. Journal of Orthopaedic Surgery and Research. 2021 Dec;16(1):1-1.
4 Kuo CH, Kuo YH, Wu JC, Chang HK, Ko CC, Tu TH, Chang CC, Yeh MY, Fay LY, Huang WC, Cheng H. Anterior Bone Loss in Cervical Disc Arthroplasty Correlates with Increased Cervical Lordosis. World Neurosurgery. 2022 Apr 4.

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