Anterior cervical discectomy with fusion (ACDF) and artificial disc replacement (ADR) are two common surgical options for treating symptoms of cervical degenerative disc disease.1 While both of these procedures are relatively safe and tend to have satisfactory outcomes for patients in most cases, these surgeries still have risks that must be considered, including:
- General risks of surgery. Every surgery that requires medications and incisions involves some risks, including the risk for an infection or allergic reaction, which could have life-altering consequences.
- Pain remains or worsens. An unsuccessful cervical spine surgery may result in symptoms not improving or possibly the development of increased pain. This is especially true if there is no imaging confirmation that aligns with symptoms of nerve root or spinal cord compression.
- Failure to fuse. Also called nonunion, it is possible for the adjacent vertebrae to not fully grow together and thus not form a solid fusion. This complication can be painful and is more likely to occur when attempting to fuse 3 or more levels.
- Paralysis. By its very nature, cervical spine surgery is performed in close proximity to the spinal cord. A variety of potential complications could result in a minor or major injury to the spinal cord, which could cause motor and sensory deficits, including parts of the body experiencing numbness and paralysis.
- Recovery complications. While most patients recover well from cervical spine surgery by carefully following the care team’s instructions, sometimes unexpected or more severe complications develop. These complications can include one or more of the following: intense pain, mental health challenges, problems with speaking and/or swallowing, side effects from medications, such as constipation or nausea, and others.
- Hardware failure. Whenever hardware is implanted in the body, there is a chance that it could fail at some point in the future, such as if a cage or artificial disc breaks.
- Surgical error. Whether it is due to lack of experience or a simple mistake or slip, it is possible for the surgeon to make an error during the procedure that leads to a less-than-satisfactory result.
Many other surgical risks may also exist and can vary from patient to patient.
Risks of Fusion Compared to Artificial Disc Replacement
There is still some debate within the medical community as to whether an ACDF (fusion) or artificial disc replacement (ADR) surgery is preferable for treating cervical degenerative disc disease. While ACDF surgery has more long-term data and is still considered the gold standard surgical option, long-term results are starting to show ADR as potentially superior in terms of reducing the risk for needing another surgery at an adjacent vertebral level.2
Some factors to consider when deciding between ACDF and ADR include:
- Artificial disc replacement is a relatively newer procedure. Fewer surgeons have experience with cervical disc replacement. There are potentially more opportunities for error during this procedure if the surgeon is relatively inexperienced in it.
- Fusion cannot be undone. Once an ACDF has been performed and the bone fused, it cannot be undone. An artificial disc, however, can be removed and followed up with a fusion.
- Hardware must last longer in ADR. In the case of a fusion surgery, the first 6 or so months are critical as the vertebrae grow together and fuse, after which the newly solid (fused) bone no longer relies on the hardware for its stability. In the case of an artificial disc replacement, the hardware, or implant, needs to last much longer as it is the permanent replacement for the degenerated disc.
Younger patients, such as those in their 30s and 40s with many years of active life ahead, are increasingly opting for artificial disc replacement surgery in an effort to preserve as much normal cervical spine motion as possible. While some evidence is emerging that the motion-sparing artificial disc replacement may reduce the risk for adjacent level disc degeneration that might require a second surgery, long-term data on these proposed benefits are still being collected.3