Cervical Spinal Fusion vs Total Disc Replacement:
Which One Should I Choose?

By Jonathan J. Rasouli, MD, The Cleveland Clinic

How Do You Choose the Right Option?

This is a very common question, and source of confusion, from patients who are trying to decide which surgical treatment—spinal fusion (Anterior Cervical Discectomy and Fusion, also known as ACDF) or total disc replacement (also known as TDR)—is best to improve their symptoms. TDR is considered an accepted alternative to ACDF for the treatment of neck and arm pain caused by a cervical disc herniation. Compared to ACDF, a TDR implant does not fuse the bones of the spine and preserves motion. Therefore, by eliminating the need for fusion, TDR is thought to restore physiologic, or natural, movements of the cervical spine and prevent accelerated degenerative changes in other levels of the spine.

The Case for Total Disc Replacement

Furthermore, there are several studies to suggest that patients who undergo TDR have less post-operative pain and return to work faster than ACDF. The ideal TDR candidate is a patient who has degenerative disc disease caused by cervical radiculopathy (pinching of the nerve in the neck region), normal spinal curvature, and no abnormal movements of the vertebral bodies (or the bones of the neck) on flexion-extension imaging. That being said, only your surgeon will know whether or not you are a good candidate for TDR.

The Case for Spinal Fusion

On the other hand, the anterior cervical discectomy and fusion procedure is a “gold standard” for cervical radiculopathy and myelopathy (compression of the spinal cord) that has been around for over 50 years. It has proven to be safe, effective, and provides predictable results. Unlike TDR, the ACDF fuses two bones of the cervical spine and results in a loss of motion in that segment. Some studies have shown that this causes changes in the normal physiologic, weight-bearing forces at adjacent levels (the discs above and below the degenerated disc) in the cervical spine and can cause accelerated degenerative changes later on in life. While most patients who develop this condition (adjacent segment disease) remain asymptomatic, a small percentage may require additional surgery in the future.

While the indications for TDR are a bit more limited, the vast majority of patients with cervical disc disease are good candidates for ACDF. Therefore, ACDF is still more commonly performed in the United States on a per annual basis.

So Which is Right For You?

Circling back around to the topic of this article—which is the best procedure for YOU? The answer is that only your spine surgeon will have the necessary education, training, and experience to decide which procedure (ACDF vs TDR) will be most effective and safest for you. In general, we reserve TDR for patients who are healthy and do not have more than 2-level degenerative disc disease. If you fall into this category, you may wish to ask your spine surgeon about TDR and see if you are a good candidate.

Important Note: The patient information presented is for general education purposes only. As with any spine surgery, there are potential benefits, complications, and risks associated with disc replacement and spinal fusion procedures. Individual results may vary. It is important that you discuss the possible risks and potential benefits of various procedures with your doctor prior to receiving treatment, and that you rely on your physician’s best judgment. Only your doctor can determine whether you are a suitable candidate for a specific surgical procedure.

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