BMN Blog

MAR 06
To Fuse or Not to Fuse: The Argument for Spinal Disc Replacement

Treatment for a pinched nerve in the neck (cervical radiculopathy) that has failed to improve with non-operative care has traditionally been treated with an anterior cervical discectomy and fusion (ACDF). Originally explained in 1958, this procedure achieves success by eliminating nerve root compression by removing the disc, replacing with bone graft via a fusion to prevent recurrent or pinched nerves and maintain stability. However, not only does this increase restricted motion to the spine (which is increased with multilevel fusions), but it also transfers force stresses to other levels or levels above and below the fusion which has been shown to increase symptoms/degeneration at other levels.


Total disc arthroplasty, comparable to a total joint replacement, relies on resection of the problem disc and insertion of an artificial disc to restore disc height, prevent pinched nerves, and maintain normal motion. Approved by the FDA in 2007, total disc arthroplasty is performed via the same incision and approach as an ACDF. It has demonstrated many advantages over ACDF including: motion preservation, earlier return to work, and a decreased incidence of same level or adjacent level surgical intervention. First, as this is a motion preservation surgery, it avoids the post-operative complication of a bony nonunion (a.k.a. pseudarthrosis) from a fusion surgery which demonstrates poorer outcomes and requires revision surgery to resolve. In addition, peer-reviewed published studies have demonstrated an earlier return to work among Workers’ Compensation patients who had an arthroplasty versus a fusion. Lastly, when comparing the need for revision surgery for same level or adjacent level pathology, studies have shown similar results when comparing single level ACDF versus arthroplasty. However, when comparing two-level ACDF versus two-level arthroplasty (the most currently approved by the FDA), the evidence strongly favors arthroplasty in decreasing future surgical needs.


I often tell my patients, “You know when you’ll need me.” Hopefully, with this information, I can also tell them, “You know WHAT you’ll need FROM me!”

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