Cervical Disc Replacement Surgery: What to Expect

What Is Cervical Disc Replacement?

Cervical disc replacement (CDR) — also called cervical total disc arthroplasty — is a surgical procedure in which a damaged cervical disc is removed and replaced with an artificial disc prosthesis that preserves motion at that spinal segment. It's an alternative to anterior cervical discectomy and fusion (ACDF), the traditional standard procedure that removes the disc and permanently fuses the adjacent vertebrae.

The key distinction: fusion eliminates motion at the treated level, while CDR preserves it — potentially reducing stress on adjacent disc levels and the risk of adjacent segment disease.

When Is CDR Performed?

CDR is performed for the same conditions as ACDF when surgery is indicated:

Cervical disc herniation causing radiculopathy (arm pain, numbness, weakness) unresponsive to 6+ weeks of conservative care
Cervical spondylosis with radiculopathy: Disc degeneration with bone spurs compressing nerve roots
Cervical myelopathy (spinal cord compression) — selected cases; severe myelopathy may still be better served by fusion

CDR requires preserved disc height and no significant facet arthritis at the involved level — if facet joints are degenerated, fusion is preferred.

FDA-Approved Artificial Disc Types

Multiple cervical disc systems are FDA-approved in the United States:

Mobi-C: Allows three planes of motion (flexion-extension, lateral bending, rotation); designed for single and two-level replacement
ProDisc-C: Semi-constrained ball-and-socket design
Bryan Disc: Unconstrained; allows physiological motion
Prestige LP, Secure-C, PCM, Kineflex-C

Selection depends on anatomy, level treated, and surgeon preference.

Day of Surgery

Pre-Operative Preparation

Same as ACDF: NPO from midnight, discontinue blood thinners, arrange driver.

Anesthesia

General anesthesia, typically 1–2 hours.

Surgical Steps (Anterior Cervical Approach)

Patient positioned supine (on back) with neck slightly extended on a headrest
Horizontal incision on the anterior neck (same incision as ACDF — left or right side)
Dissection to the spine through the tissue planes (no muscle cutting; dissects between muscles)
Fluoroscopy confirms correct level
Damaged disc fully removed (discectomy)
Bone spurs decompressing the nerve root and/or spinal cord removed
End plates of the vertebrae prepared to receive the implant
Artificial disc implant placed — sized and positioned to restore disc height and alignment
Fluoroscopy confirms implant position
Wound closed (no drain needed)

Recovery Room and Discharge

Most patients are discharged same day or with a 1-night hospital stay.

Advantages Over Fusion (ACDF)

Evidence from multiple randomized clinical trials comparing CDR to ACDF shows:

Equivalent neurological outcomes: Pain, arm symptoms, and strength recovery are comparable
Lower rate of adjacent segment disease: CDR patients have lower rates of symptomatic adjacent level problems requiring surgery at 5–7 year follow-up
Faster return to work reported in some studies
No need for bone graft or fusion hardware failure

Recovery After CDR

CDR recovery is generally faster than lumbar surgery and similar to or faster than ACDF:

Soft collar: May be prescribed for 1–2 weeks (not all surgeons use this)
Return to desk work: 1–2 weeks
Lifting restrictions: 10–15 lbs for 4–6 weeks
Return to full activity: 4–8 weeks for most patients
PT: Cervical exercises begin 2–4 weeks post-op; progress to strength and range of motion work

Avoid: Contact sports and high-impact activities for 3–6 months.

Risks Specific to CDR

Implant migration or subsidence (sinking into vertebral body)
Heterotopic ossification (HO): Bone forming around the implant can eventually fuse the segment, negating motion-preservation benefit
Implant failure requiring revision or conversion to fusion
Same risks as any anterior cervical surgery: hoarseness (recurrent laryngeal nerve), swallowing difficulty, infection