Anterior Cervical Discectomy and Disc Replacement - ACDR

ACDR flexion x-ray

Procedure

Removal of a slipped disc through the front of the neck and replacement with an artificial disc. There are different models on the market. The idea is that the segment will continue to move unlike a spinal fusion.

Indication

Decompression of spinal cord and nerve roots

Prevention of degeneration of adjacent levels

Risks

Infection, bleeding, CSF leak, neurological damage including paralysis, hoarse voice which is usually transient but can be permanent, stroke, no improvement of symptoms, death in cases of high cervical cord injuries, failure of inserted disc replacement Overall, it is a standard and safe procedure, which has small but potentially very serious risks.

Hospital stay

24-48 hours after operation in majority of cases

Anaesthesia

Always general anaesthesia

ACDR extension x-ray

Recovery

The neck might feel sore for a short time and sometimes can radiate between the shoulder blades. Patients can experience slight discomfort when swallowing for a few days after the operation. A collar is not routinely necessary post operatively.

Commonly asked questions

What is the difference between the disc replacement and fusion?

The fusion will immobilise the moving segment between two vertebras. The concern is that other discs have to make up for the loss of movement, which might accelerate wear and tear at other levels. A disc replacement will restore the ability to move. Although this seems plausible, there is little convincing evidence in the literature for this. The prosthesis will also wear out with time (like any other artificial joint replacement) and might fuse. There is also a small risk of immediate fusion with the artificial disc. Disc replacements are usually limited to patients under the age of 50. The reason is that after this age the degenerative changes of the effected level are quiet marked and it is might not be possible to restore the movement. However, degenerative changes vary significantly in different patients and if the overall wear and tear is limited, than patients older than 50 years might also benefit. There is no significant difference in the overall outcome for the radiculopathy or myelopathy. The implant is, however, around three times more expensive than a cage.