SHOULD I HAVE A CERVICAL FUSION OR ARTIFICIAL DISC REPLACEMENT (TDR)
Anterior cervical discectomy and fusion (ACDF) is the second most common type of spinal surgery in the United States. This is mostly considered to be an outpatient surgery and can be performed in a surgery center or in a hospital as an outpatient. In either situation, patients typically go home 2-3 hours following surgery.
Although exact numbers are not readily available, the cervical TDR’s compromise 10-15% of the anterior cervical surgeries performed in the United States. This means that anterior cervical fusions are 7-10X more commonly performed than artificial disc replacement surgeries. This disparity is curious when you consider that most studies show superior long term outcomes for the TDR’s compared to the ACDF’s. Studies with 2 year follow up show faster recoveries in these patients with less pain which lessens the need for postoperative care including PT, pain medications, injections, and psychological care. Preservation of motion has the long term benefit of decreasing the risk of requiring a second cervical fusion at the adjacent level by 7 fold.
Then why are total disc replacements not being performed more commonly, especially in younger patients? The reasons are manifold - some surgeons simply do not trust the technology and feel more comfortable with ACDF’s which has been around for ~ 70 years. In comparison, the cervical artificial disc was first placed in the United States 25 years ago, and the current generation discs have been around ~ 10 years. Proponents of TDR’s, however, point out that these devices were placed in Europe 10 years prior to it being done in the US. The other undeniable factor is a financial one related to the cost of implants. Depending on the local/regional health insurance situation, it can be cheaper for the hospital or surgery center to perform ACDF’s compared to TDR’s. The reimbursement for the surgeon is also much less for the TDR compared to the ACDF even though the approach, risk and length of surgery is nearly identical.
In summary, younger patients will likely benefit from having a total disc replacement over an ACDF. Patients older than 60 years of age generally are not as good candidates because of relative contraindications. However, this is not an absolute rule. A qualified spine surgeon who routinely performs both procedures is in the best position to help make this decision.