Cervical Disc Replacement or Fusion - Which is best for you?

Fusing a disc inevitably transfers work to the adjacent discs. So, unless there is a good reason to fuse the spine, the usual course is a disc replacement as this offers to restore and or preserve movement at the affected level.

Disc replacement is therefore now more common than fusion after disc removal though the evidence that it is actually better is not as tight as you might think. Both operations are good. Your big decision is whether to have surgery or not. If you have spent more time thinking about replacement vs fusion your mind has been focused on the wrong issue - though this is an important decision too.

Fusion is needed if there is significant instability at the operated level – spondylolisthesis or if there is a fracture as well as a prolapse.

Fusion is also used if the disc space is already very narrow when the movement has already been lost. If the facet joints are also worn and painful then disc replacement can make this worse. Finally, if there are a lot of osteophytes then these have to be drilled away. As a result of this bone work, the two vertebrae can fuse around the replacement – this happens more often with some discs than others and may occur as many as one in ten times.

Disc replacement is not a guarantee of no more trouble nor does it prevent all disease in the adjacent levels. You wore out the first disc without having had a fusion so you may also wear out another. That said, our philosophy is to preserve and restore function where possible.

Is there good evidence to prove disc replacement is better? Not in the form of randomised trials. Such trials are difficult to do, they have been flawed and to some degree inconclusive. In our view, this reflects the difficulty of doing this kind of study. For most patients, a logical choice can be made and where there is doubt we would opt for disc replacement – you can fuse after if it does not work but you cannot reverse a fusion.

Cervical Disc Replacement

Cervical disc is a piece of specialized tissue that separates the vertebral bones of the spinal column in the neck. Cervical disc disease is caused by an abnormality in one or more discs. When a disc is damaged due to arthritis or an unknown cause it can lead to neck pain from inflammation or muscle spasm. Severe pain and numbness can occur in the arms from pressure on the cervical nerve roots. The disc space is jacked up to its prior normal disc height to help decompress (relieve pressure) on the nerves. In severe cases, when the patient is not benefited from non-surgical treatments like medication or physiotherapy then they are advised Cervical Disc Replacement Surgery.

The Center of the disc, which is called the nucleus, is soft, springy and receives the shock of standing, walking, running, etc. The outer ring of the disc, which is called the annulus (Latin for ring), provides structure and strength to the disc. Patients with cervical disc herniations are advised cervical disc replacement, if they have not responded to non-surgical treatments like medication or physiotherapy.In the surgery, an artificial disc replaces the worn out or affected one and the disc space is jacked up to the normal height.

Spinal Fusion

Once you have had your offending disc removed, a simple fusion procedure can be performed as the cervical spine reconstruction.

This is usually performed with a plate and integrated cage (PCB). This is filled with recycled bone collected during the decompresion of the spine in addition to some synthetic bone supplement. Usually no additional bone needs to be taken from the pelvis. Profesional athletes involved in heavy contact sport such as rugby may wish to utilise their own pelvic bone as it is still probaly provides for the fastest and most secure fusion. Return to play is often possible at three months. 

the device, filled here with synthetic bone, is ready for insertion. This technique obliviates the need for a separate incision and the harvesting of the patient’s bone from elsewhere, e.g. the pelvis.

After Surgery

Patients are usually able to get out of bed within an hour or two after surgery. Your surgeon may have you wear a hard or soft neck collar. If not, you will be instructed to move your neck only carefully and comfortably.
Most patients leave the hospital the day after surgery and are safe to drive within a week or two. People generally get back to light work by four weeks and can do heavier work and sports within two to three months.
Outpatient physical therapy is usually prescribed only for patients who have extra pain or show significant muscle weakness and deconditioning.

Rehabilitation

Patients usually don't require formal rehabilitation after routine cervical discectomy surgery. Surgeons may prescribe a short period of physical therapy when patients have lost muscle tone in the shoulder or arm, when they have problems controlling pain, or when they need guidance about returning to heavier types of work. If you require outpatient physical therapy, you will probably only need to attend therapy sessions for two to four weeks. You should expect full recovery to take up to three months.
At first, therapy treatments are used to help control pain and inflammation. Ice and electrical stimulation treatments are commonly used to help with these goals. Your therapist may also use massage and other hands-on treatments to ease muscle spasm and pain.
Active treatments are added slowly. These include exercises for improving heart and lung function. Walking, stationary cycling, and arm cycling are ideal cardiovascular exercises. Therapists also teach specific exercises to help tone and control the muscles that stabilize the neck and upper back.


Your therapist works with you on how to move and do activities. This form of treatment, called body mechanics, is used to help you develop new movement habits. This training helps you keep your neck in safe positions as you go about your work and daily activities. You'll learn how to keep your neck safe while you lift and carry items and as you begin to do other heavier activities.

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