Dr. Lieberman: Should I have ACDF or an artificial disc replacement surgery?

Dan Lieberman, MD is a neurological surgeon and medical director of Phoenix Spine and Joint. He has done over 2,000 ACDF and participated in the manufacturer trials of artificial discs. In this video he examines the question above. Mobile implants release debris, is this a problem? Do artificial discs really preserve motion? Is the pain relief from ACDF and artificial disc the same? A recent paper reporting the 10 year outcomes of the Prestige artificial disc sheds light on these important questions.

The cervical artificial disc and ACDF are both major surgeries but they are well tolerated. The scar in the front of the neck is the same between the two surgeries. The surgery itself is about the same for the two procedures. Both are now done on an outpatient basis, and do not require hospitalization. Patients are usually mostly recovered in 3 days, ready to return to light work in 7 days, but are restricted from heavy lifting after 12 weeks.

The paper reviewed pain, patient satisfaction, range of motion, adjacent levels disease, and the levels of debris in the blood after ACDF and cervical artificial disc replacement. Cervical artificial disc replacement relieves neck pain as well as the legacy ACDF surgery. Patients report high satisfaction with both procedure. X-rays confirmed motion preservation in the artificial disc group which was maintained over 10 years, but the improvement was only around six degrees. The cervical artificial disc did not make a big difference in problems with the disc adjacent the surgical level. Blood levels of metals were not substantially higher in patients with the artificial cervical discs despite these being moving implants. There was no sign of device failure during the 10 year trial, so the available data indicates that cervical discs will last as long as you will.

Is cervical artificial disc replacement better than fusion? Overall this information strongly suggests the cervical artificial disc is a great alternative to legacy ACDF fusion surgery. Younger patients who are especially concerned about range of motion should request a cervical artificial disc from their surgeon. For everyone else, both surgeries are good options. It's nice to have two good alternatives.