Question 1

What is the difference between cervical disc replacement and ACDF?

Accepted Answer

Both procedures remove the damaged disc and decompress the nerve. The difference is what goes in afterward. In ACDF, a bone graft or cage is placed and the two vertebrae are fused into one solid segment — the motion at that level is permanently eliminated. In disc replacement, an artificial disc is implanted that preserves the normal motion of the segment. Both relieve symptoms effectively; the question is which approach is better for your long-term spine health.

Question 2

How long does a cervical artificial disc last?

Accepted Answer

Current data extends to 10+ years, and the devices are designed to last a lifetime. Unlike hip or knee replacements, cervical artificial discs don't bear weight the same way and have very low wear rates in the clinical literature. Reoperation rates for device failure are low — under 3% in the major FDA trials at 7-year follow-up.

Question 3

Will I need a neck brace after surgery?

Accepted Answer

I typically place patients in a cervical collar for two weeks, which means no driving during this time.

Question 4

Can disc replacement be done at two levels?

Accepted Answer

Yes. Several cervical disc replacement devices are FDA-approved for two-level use. The clinical data for two-level replacement is strong — and the advantage over fusion may actually be greater at two levels, because preserving motion at two segments has a larger protective effect against adjacent segment disease.

Question 5

Can more than two levels be replaced?

Accepted Answer

The FDA studies that got artificial discs approved only included one and two-level patients — so the two-level limit is really a study design limitation, not a clinical one. There are patients who have had three or even four-level disc replacements. This is considered off-label, and most insurance won't cover it, but off-label use is common in surgery when the clinical reasoning supports it. Whether it makes sense for you depends on your anatomy, bone quality, and the condition of the facet joints at each level. I'll give you an honest assessment during the consultation.

Question 6

Why not just do a posterior microdiscectomy in the neck like we do in the lower back?

Accepted Answer

This is a nuanced question. In the lumbar spine, the spinal cord has already ended, so we're working around nerve roots that can be gently moved aside. In the cervical spine, the spinal cord is right there — and retracting it too aggressively can cause serious complications, including paralysis. So for central or paracentral disc herniations, a posterior approach isn't safe. For herniations that are more lateral or in the foramen, there is a procedure called a foraminotomy where we go through the back of the neck and shave down the disc. I used to do this more often, but I've shifted toward disc replacement for most of these patients because the foraminotomy requires cutting or dilating the posterior neck muscles and removing part of the facet joint. I've seen more posterior neck pain and muscle atrophy after foraminotomies than I'd like. With disc replacement, you cut no muscles on the way in.

Question 7

What about difficulty swallowing after surgery?

Accepted Answer

Some difficulty swallowing in the first day or two is common and usually resolves quickly. It can become more of a persistent issue with long-segment fusions or fusions higher in the cervical spine — around C3-4 — because we bend our neck to swallow, and losing that motion affects the mechanics. Plates used in fusion can contribute as well. With disc replacement, I see this problem less frequently.

Question 8

What is the risk of voice changes?

Accepted Answer

There's roughly a 1–2% risk of recurrent laryngeal nerve injury, which can cause hoarseness. It's usually temporary but can occasionally be permanent. I take this seriously in every patient, and I pay particular attention when someone uses their voice professionally — singers, teachers, attorneys, broadcasters. If you've had a prior surgery on the front of the neck, that's also something we discuss carefully because a bilateral nerve injury, while very rare, can be devastating.

Question 9

Am I too old for disc replacement?

Accepted Answer

There isn't a strict age cutoff. The key factor is the condition of your facet joints and bone quality, not your age. I've performed disc replacement on patients in their 60s who had excellent facet joints. Conversely, some 40-year-olds have too much arthritis for disc replacement. The imaging tells the story.

Question 10

What are the risks of cervical disc replacement?

Accepted Answer

The risks are similar to ACDF since it's the same surgical approach. The main ones: hoarseness from recurrent laryngeal nerve irritation (1–2%), temporary difficulty swallowing, bleeding in the neck (rare but serious — this is why I send every patient home with a small drain), infection (very low for anterior cervical surgery), nerve root injury, spinal cord injury, and a phenomenon called C5 palsy where stretching the spine can put tension on the shortest cervical nerve root. The cosmetic scar is placed in a natural skin fold and typically fades significantly over six months to a year. This isn't an exhaustive list — I'll go through the specific risks relevant to your anatomy during the consultation.

Cervical Disc Replacement in Orange County, CA

When I recommend disc replacement over fusion

How the procedure works

Recovery

The devices I use

What the evidence says

When fusion is still the right call

Frequently Asked Questions