- Cervical disc replacement (arthroplasty) aims to relieve compression and preserve neck motion, unlike fusion (ACDF).
- Not everyone is a candidate: selection depends on symptoms, imaging, alignment, and the condition of the facet joints.
- Typical recovery for office work is 2–3 weeks and 4–6 weeks for an active lifestyle without heavy exertion, if there are no complications.
- As with any surgery, there are risks (dysphagia, infection, implant failure), although recent evidence shows high success rates in well-selected patients.
What is cervical disc replacement?
It is a procedure that replaces a damaged cervical disc with a mobile prosthesis designed to mimic the biomechanics of the natural disc. The goal is to decompress nerves or the spinal cord and preserve mobility at the treated segment. Unlike fusion (ACDF), which eliminates motion at that level, the prosthesis maintains a range of motion close to physiological.
Common symptoms and indications
- Neck pain radiating to the shoulder or arm, tingling or weakness due to nerve root compression.
- Cervical stiffness and axial pain that does not improve with well-executed conservative treatment.
- In some cases, signs of spinal cord involvement (myelopathy): hand clumsiness, gait instability, changes in reflexes.
Surgery is considered when symptoms persist or progress after weeks/months of non-surgical management and when clinical–radiologic correlation is clear.
How is the diagnosis confirmed?
- Magnetic resonance imaging (MRI): identifies herniations, osteophytes, and neural compression.
- Dynamic X-rays: help assess alignment and stability.
- Neurological exam: strength, sensation, and reflexes; dexterity and gait tests.
Selected cases may include neurophysiological studies. Diagnosis is not based on a single test, but on the “convergence” of findings and functional impact.
Treatment alternatives
Non-surgical approach
- Education and activity modification, ergonomics, and active breaks.
- Medications (simple analgesics; adjuvants if neuropathic pain is present, always under medical supervision).
- Physical therapy focused on motor control and scapulocervical strengthening; graded exercises.
- Selective diagnostic/therapeutic injections in specific cases.
Surgical alternatives
- ACDF (discectomy and fusion): reliable for decompression and stabilization, at the cost of losing motion at the treated level.
- Cervical disc replacement: preserves motion and may reduce overload of adjacent levels in appropriate candidates.
Expected benefits versus risks and adverse effects
Benefits
- Relief of radicular pain and recovery of arm strength/sensation in most cases.
- Maintenance of segmental neck mobility.
- Less postoperative stiffness and, in suitable profiles, a quicker return to daily activities.
- Possibly lower incidence of adjacent-level surgery in the mid-term compared with fusion.
Risks and limitations
- General: bleeding, infection, anesthetic complications.
- Specific: transient dysphagia and dysphonia, rare neural injury, implant malposition or wear, heterotopic ossification (may limit motion over time).
- Does not fully eliminate axial neck pain if other sources coexist (e.g., facet arthropathy).
Who is (and is not) a candidate?
- Good candidates: 1–2 levels of soft-disc herniation or degeneration (some centers in Europe extend to 3), acceptable alignment, no advanced facet arthritis, no significant instability or deformity.
- Common contraindications: segmental instability, marked osteoporosis, severe facet arthritis, extensive ossification of the posterior longitudinal ligament, active infection, unstable acute trauma.
The decision is individualized after reviewing medical history, imaging, and patient goals.
Realistic expectations and recovery timelines
- Pain and swallowing: swallowing discomfort usually improves within days to weeks.
- Mobility: early initiation of gentle motion; progressive range-of-motion gains over 6–12 weeks.
- Work: office duties in 2–3 weeks; physical jobs from 6 weeks onward with progression and medical clearance.
- Sports: low-impact aerobic activity in 3–4 weeks; guided strength training from 6–8 weeks.
Timelines depend on individual progress and comorbidities.
When to go to the emergency department
- Sudden or progressive loss of strength in the arm or hand.
- High fever with severe neck pain or wound redness.
- Breathing difficulty or inability to swallow liquids.
- Pain worsening day by day despite medication or the appearance of new neurological symptoms.
Myths and realities
- “The prosthesis is better than fusion in every case.” Reality: it is superior only in appropriate profiles; selection is key.
- “With a prosthesis there will be no reoperations.” Reality: risk exists, though studies show low rates with correct indications.
- “I will regain full mobility.” Reality: motion is preserved, but not always identical to natural.
Frequently asked questions
Does the prosthesis last “forever”?
Mid- to long-term series show good performance; even so, over the years heterotopic ossification or wear may limit motion and, rarely, require revision.
Can I have two levels operated?
In Europe it is possible in selected cases; the decision depends on your anatomy, symptoms, and tests.
Is it more painful than a fusion?
Postoperative pain is usually manageable and functional recovery is swift; however, it varies between individuals.
Does the prosthesis prevent “adjacent segment degeneration”?
It may reduce its likelihood over time, but does not eliminate it completely.
When can I drive?
When you are not taking sedating medications and have sufficient mobility/analgesia to react safely, generally after 1–2 weeks.
What if I have Ehlers–Danlos or another connective tissue disorder?
It requires very careful evaluation; fusion is sometimes preferred for stability reasons. Consult an experienced team.
Glossary
- ACDF: anterior cervical discectomy and fusion; stabilizes two vertebrae by eliminating motion at the level.
- Cervical arthroplasty: disc replacement with a mobile prosthesis to preserve motion.
- Heterotopic ossification: bone formation around the implant that can limit motion.
- Adjacent segment degeneration: accelerated wear in nearby discs after losing motion at one segment.
If you are considering options for your neck pain and want expert input, request a medical evaluation with a spine specialist or through accredited telemedicine services.
References
- Cervical Disc Replacement – Specialties (doctor’s information page). https://drgilete.com/specialties/cervical-surgery/cervical-disc-replacement/
- Chen CM, et al. Cervical Disc Arthroplasty vs ACDF (2024 review). https://www.mdpi.com/2077-0383/13/11/3203
- Huang WD, et al. 2025 meta-analysis (CDA vs ACDF). https://thejns.org/spine/view/journals/j-neurosurg-spine/42/6/article-p705.xml
- Badhiwala JH, et al. Adjacent-level surgery at 7 years (2020). https://jss.amegroups.org/article/view/4881/html
- Instituto Clavel – Cervical arthroplasty (public information). https://www.institutoclavel.com/es/blog/artroplastia-cervical
- Spanish-language encyclopedia (BWH) – Cervical disc replacement. https://healthlibrary.brighamandwomens.org/spanish/TestsProcedures/Neurological/135,6es
This article is educational and does not replace individualized medical consultation.
