Should You Get ACDF or Cervical Disc Replacement Surgery?

ACDF and disc replacement surgery can both take your neck pain and radiculopathy away. Which one’s right for you? Learn about how they’re similar and different to help you choose.

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Neck pain can be funny (funny weird, not funny-ha-ha). If you actually feel it in your neck, it’s probably a muscle strain—aka, not very serious. If, instead, you feel numbness, tingling, weakness or straight-up agony in one of your arms, you might have a more serious neck problem that’s causing radiculopathy—radiating pain. And when you have radiculopathy, you’ll do almost anything to get rid of it.

CDR ACDFCervical spine problems can often cause pain to radiate into one arm. ACDF and CDR are both procedures that can help. Which one is right for you?

If your pain hasn’t gone away within about six weeks, it’s time to see the doctor. And if you try the conservative treatments that your doctor will recommend (activity modification, physical therapy, anti-inflammatories) without success, it may be time to bring out the big guns. That usually means one of two surgical procedures: Anterior cervical discectomy and fusion (ACDF), or cervical disc replacement.

The whole goal for these surgeries initially is to take the pressure off a nerve root or, less commonly, the spinal cord, says Rahul Shah, MD, board certified orthopedic spine and neck surgeon with Premier Orthopaedic Spine Associates. Which one is right for you? That depends, he says, on your individual needs and your medical history. But if you want to know how these procedures are similar to and different from each other, you’ve come to the right place.

What is ACDF?

ACDF has been around since the 1950s and it’s the most common cervical spine operation performed in the U.S., estimated at about 137,000 operations per year. It’s considered the gold-standard surgery for cervical disc degeneration. “Anterior cervical discectomy and fusion” is a mouthful, so let’s break down what each of those words means:

  • Anterior: Your surgeon will make an incision through the front of your neck, as opposed to the rear or the side
  • Cervical: That’s doctor-speak for the seven vertebrae that make up the neck
  • Discectomy: Removing a herniated, bulging or otherwise damaged intervertebral disc, which acts like the spine’s shock absorbers. There’s one between each vertebra
  • Fusion: A surgeon places a bone graft between two or more vertebrae, which eliminates painful or dangerous movement

The bone graft inserted in the space may be done using autograft (taken from the patient’s hip) or allograft (the bone comes from other sources), and it allows the bone to set up a bridge or fusion between the bones of the spine. The fusion component means a bone graft will grow together with the vertebrae. The goal with fusion is to eliminate potentially painful movement.

What Is Cervical Disc Replacement?

Cervical disc replacement surgery is similar to ACDF in that the damaged disc will be removed, but now an artificial disc is put in its place. Your doctor also might refer to this surgery as anterior disc replacement or cervical disc arthroplasty. The goal here is not fusion; rather, the arthroplasty device helps retain the neck’s normal range of motion.

If the problem is relegated to just the disc and it's only one or two discs, then either the cervical disc replacement or a fusion can work to maintain that disc space once you've removed the disc, says Dr. Shah. ACDF and anterior disc replacement both are surgery in the front of the neck.

“The challenge is that wherever we have movements, anything that moves can fail or can wear out,” he says. “So wherever that wearing out occurs and there's pressure on the nerves, oftentimes this cervical surgery is performed and the thing that’s causing pressure on the nerve has been removed.”

First described in 1966, disc replacement came into wider use in the early 2000s and has gone through multiple generations using different technologies, different mobile-bearing surfaces, and different polymers, says Dr. Shah.

There are multiple ways of maintaining that space once the disc is removed. “We used to use the patients’ hip bones, then we shifted over to using donated bone from bone banks, now some people use plastic cages, metal cages, some put an artificial plate on, and others don’t put a plate on the metal cage,” Dr. Shah says.

With disc replacement, the artificial disc has to attach to bone to be able to work, because it needs two edges to be able to swivel off of, explains Dr. Shah. You’re putting a hinge in the front of the neck to allow it to maintain its motion.

Some experts and literature say that disc replacement may be better for younger people because it preserves motion and it helps prevent other areas of the spine from wearing out. But, we're finding other discs can still wear out with cervical disc replacement surgery, Dr. Shah says.

For all intents and purposes, ACDF and disc replacement are the same surgery. The only difference—and admittedly it’s a big one—is that surgeons implant a bone graft in ACDF so the vertebrae fuse together and stop painful movement. In a disc replacement, they implant an artificial disc to preserve the movement of the vertebrae.  

“The artificial discs do preserve motion, but the question of ‘do they necessarily work to prevent unintended consequences of other discs wearing out,’ -- the answer is not yet clear,” says Dr. Shah. “The number of people that qualify for disc replacement is going to be less than the number of people that qualify for fusion.”

Success Rates for ACDF and Cervical Disc Replacement

Overall, both ACDF and cervical disc replacement surgeries have good success rates when it comes to reducing pain. ACDF has longer-term studies since it’s been around for far longer.

One 10-year follow-up study found that patients who received ACDF surgery had significant reduction in narcotic pain medications, improvements in neurological issues and self-reported success rates. Another study found that approximately 15 percent of patients needed revision surgeries (i.e. another operation) after ACDF.

The cervical disc replacement surgery patients in yet another study showed much higher improvements in range of motion during post-operation and follow-up visits. The CDR patients on the whole needed fewer revision surgeries, and other parts of their neck stayed healthier compared to ACDF patients.

Cervical Disc Replacement and ACDF Recovery Times

The recovery for ACDF surgery and cervical disc replacement is pretty much the same. You’ll probably stay overnight in the hospital, but you can resume normal activities within a week or so. Your doctor may recommend a neck collar.

CDR ACDF neck collarYour doctor may recommend a neck collar in the initial stages of your recovery from surgery.Full recovery is estimated at about six weeks. “Because you go through the throat for both of these surgeries, you'll have some difficulty swallowing, but that typically gets better fairly quickly,” says Dr. Shah

The goal of both surgeries is to salvage whatever nerve function you have. “[Surgeons] pay attention to a large extent as to whether it should be disc replacement versus a fusion,” says Dr.  Shah. “But the whole goal is if you're getting significant neck pain and significant arm pain, disc replacement may be for you or fusion might for you. Maybe neither of them are for you, but you should definitely get them checked out. These are all individualized decisions that you should discuss with your physician to see what the best fit is for you.”

Updated on: 09/21/20
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