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Drew Albert

July 13, 2025

What is Cervical Disc Arthroplasty?

Cervical disc arthroplasty is a surgical procedure designed to relieve pain and restore motion in your spine by replacing a damaged or degenerated spinal disc with an artificial one. Your spinal discs are the soft, cushion-like structures between the bones (vertebrae) of your spine. They act like shock absorbers, allowing flexibility and movement while keeping your spine stable. Over time, discs can wear out, become herniated, or cause pain due to conditions like degenerative disc disease.

When non-surgical treatments like physical therapy, medications, or injections don’t provide enough relief, disc arthroplasty may be an option.Unlike spinal fusion, which permanently joins two vertebrae together to stabilize the spine, disc arthroplasty aims to preserve natural motion.

The artificial disc mimics the function of a healthy disc, allowing you to bend, twist, and move more naturally after surgery.

Surgical Indications for Cervical Disc Arthroplasty?

  • Single-level cervical radiculopathy due to degenerative disc disease: CDA is indicated for patients with single-level cervical radiculopathy from degenerative disc disease who have failed appropriate conservative management. Multiple randomized controlled trials and meta-analyses demonstrate that CDA provides outcomes comparable or superior to anterior cervical discectomy and fusion (ACDF) in selected patients, with benefits including lower rates of secondary surgery and better preservation of motion. The literature supports use in both one- and two-level disease, provided there is no significant instability, deformity, or severe facet arthropathy (Joaquim et al., 2019; Chen et al., 2024).
  • Symptomatic radiculopathy due to herniated nucleus pulposus: CDA is appropriate for patients with radiculopathy (arm pain, numbness, or weakness) refractory to at least 6 weeks of conservative therapy, or sooner if there is progressive neurological deficit. This is supported by randomized trials and meta-analyses showing efficacy and safety of CDA in this population (Joaquim et al., 2019; Hu et al., 2016; Gao et al., 2015; Gutman et al., 2018).
  • Cervical myelopathy: CDA is an option for select patients with mild to moderate cervical myelopathy due to one- or two-level degenerative disc disease, provided exclusion criteria such as instability, kyphotic deformity, or severe facet degeneration are absent. Recent reviews and comparative studies confirm that CDA can be considered in this context, with outcomes similar to ACDF in appropriately selected patients (Tu et al., 2023; Ko et al., 2023).

Absolute Contraindications to Cervical Disc Arthroplasty

Relative Contraindications to Cervical Disc Arthroplasty

These are areas that are debated among spine surgeons. 

  • Segmental kyphosis 5–10° at the index level (Patel et al., 2024)
  • Loss of disc height 50–75% (1.5–3 mm) (Patel et al., 2024)
  • Bridging osteophytes without complete ankylosis (Patel et al., 2024)
  • Prior cervical spine surgery at a different level (Patel et al., 2024)
  • Less-mobile disc (preoperative range of motion ≤5°) (Tu et al., 2019)
  • Mild facet arthropathy (Nunley et al., 2018). There are some spine surgeons that have observed cervical disc arthroplasty offloads the forces across the facet joints allowing patients to preserve motion at the operative level.
  • Poor general medical condition or high anesthetic risk (McAfee, 2004)
  • Age is considered a relative contraindication to cervical disc arthroplasty (CDA), but not an absolute one. Early clinical trials and device labeling for CDA typically limited inclusion to patients between 18 and 60 years, reflecting concerns about poorer bone quality, higher rates of spondylosis, and comorbidities in older adults. However, more recent evidence suggests that CDA can be performed safely and effectively in selected elderly patients. Multiple studies have shown that while older patients (typically ≥65 years) may have slightly different perioperative profiles—such as a trend toward increased perioperative complications or a small reduction in segmental range of motion—clinical outcomes, complication rates, and prosthesis mobility are generally comparable to those in younger patients over short- and mid-term follow-up. (Wu, 2019; Ajoku, 2023). Notably, a retrospective cohort analysis found no significant differences in clinical or functional outcomes between typical candidates and those with relative contraindications, suggesting that strict age cutoffs may be unnecessarily restrictive (Patel, 2023).
  • Axial neck pain. Meta-analyses and systematic reviews confirm that CDA is effective for both neck and arm pain in appropriately selected patients, and that the presence of axial neck pain alone does not preclude favorable outcomes. Therefore, current evidence supports that axial neck pain is not a relative contraindication to cervical disc arthroplasty (Gao, 2015, Cepoiu, 2011; Gao, 2013; Zara’s, 2024).
  • Prior fusion at index level: There is early research by a few surgeons that consider taking down previously fused levels to convert them to disc arthroplasty, but this is still experimental. More studies are needed.
  • Multilevel disease (>2 levels): The current evidence indicates that cervical disc arthroplasty (CDA) at three or four levels is feasible and can be safe and effective in carefully selected patients, but high-quality data are limited and this remains a relative contraindication. Most robust evidence and FDA approvals are for one- or two-level CDA, with strong support for safety, efficacy, and motion preservation in these settings. For three- and four-level CDA, the literature consists primarily of retrospective series, systematic reviews, and meta-analyses, which suggest that outcomes—including pain relief, functional improvement, and preservation of motion—are comparable to single- and two-level CDA, and may be superior to multilevel ACDF in terms of adjacent segment degeneration and overall motion (Tu, 2023; Joaquim, 2017; Alves, 2021; Wu 2017; Zhao, 2015).

Does Cervical Disc Arthroplasty Prevent Adjacent Segment Disease?

Note: What is adjacent segment disease? This is a clinical and radiographic diagnosis where the levels surrounding a fusion level can break down due to higher stress on those levels. When these levels surrounding a fusion breaks down they can produce symptoms due to pinched nerves or spinal cord. Cervical disc arthroplasty preserves motion in an attempt to decrease the stress on adjacent levels.

Cervical disc arthroplasty (CDA) is associated with a lower incidence of adjacent segment disease (ASD) compared to anterior cervical discectomy and fusion (ACDF), but it does not completely prevent ASD. Multiple high-quality meta-analyses and randomized controlled trials demonstrate that CDA reduces the risk of both radiographic adjacent segment degeneration and clinically significant ASD, as well as the need for adjacent segment reoperation, relative to ACDF over mid- to long-term follow-up (Latka et al., 2019; Foley et al., 2024; Zhu et al., 2016; Toci et al., 2022; Luo et al., 2018; Dong et al., 2017). For example, pooled data from meta-analyses show a statistically significant reduction in ASD and reoperation rates with CDA versus ACDF, with risk ratios for ASD and reoperation favoring CDA.

However, the absolute risk of developing ASD is not eliminated by CDA, and some studies with long-term follow-up report that the difference in clinically significant ASD or reoperation rates may not always reach statistical significance, or that the benefit may diminish over time (Ghobrial et al., 2019; Goedmakers et al., 2023; Verma et al., 2013; Yang et al., 2012). Notably, a recent double-blinded randomized controlled trial found no significant reduction in clinically relevant adjacent segment disease at five years with CDA compared to ACDF (Goedmakers et al., 2023).

In summary, CDA reduces but does not fully prevent adjacent segment disease when compared to ACDF, and the magnitude of benefit may vary depending on patient selection, prosthesis type, technique, and duration of follow-up.

How Does Disc Arthroplasty Work?

The procedure is performed under general anesthesia, meaning you’ll be comfortably asleep. Here’s a step-by-step overview of what happens:

  1. Accessing the Spine: I make a small incision in the front of your neck to reach the spine. This approach avoids cutting through the muscles and follows the natural fascial planes, which can lead to a faster recovery.
  2. Removing the Damaged Disc: The problematic disc is carefully removed to relieve pressure on nearby nerves or the spinal cord, which may be causing your pain, numbness, or weakness.
  3. Inserting the Artificial Disc: A specially designed artificial disc, made of medical-grade materials like metal and high-strength plastic, is placed into the empty disc space. These devices are engineered to mimic the natural movement of your spine and are built to last for many years.
  4. Closing and Recovery: The incision is closed, and you’ll begin the recovery process, which allows patients to go home the same day, depending on the complexity of the surgery and your overall health.

Why Choose Disc Arthroplasty?

Disc arthroplasty is often recommended for patients with specific conditions, such as:

  • Degenerative Disc Disease: When a disc wears out and causes chronic pain.
  • Disc Herniation: When a disc bulges or ruptures, pressing on nerves.
  • Chronic Back or Neck Pain: When pain persists despite non-surgical treatments.

The key advantage of disc arthroplasty over traditional spinal fusion is motion preservation. By maintaining flexibility in the treated area, artificial disc replacement may reduce stress on adjacent discs, potentially lowering the risk of future problems. Many patients also report improved mobility and a faster return to daily activities compared to fusion.

Is Disc Arthroplasty Right for You?

Not every patient is a candidate for disc arthroplasty. It’s typically best for those who:

  • Have pain primarily from one or two damaged discs.
  • Are relatively young and active, with healthy bones and no severe arthritis in the spine.
  • Have tried non-surgical treatments without success.
  • Do not have severe spinal instability, deformity, or other conditions that might require fusion.

During your consultation, we’ll review your medical history, imaging (like X-rays, CTs or MRIs), and symptoms to determine if this procedure is a good fit. My team and I are committed to taking the time to listen to your concerns and explain every step so you feel confident in your care.

Why Trust Us for Your Care?

At our practice, we believe in treating you like family. My team and I are dedicated to providing compassionate, cutting-edge care tailored to your unique needs. Disc arthroplasty is just one of the advanced tools we use to help you live a fuller, pain-free life. If you’re struggling with back or neck pain, let’s work together to explore whether this procedure—or another approach—can help you get back to the activities you love.If you have questions or want to schedule a consultation, please reach out. We’re here to guide you every step of the way.

Note: For more details or to discuss your specific condition, contact our office or visit our website’s contact page. Your journey to relief starts with a conversation.

References:

  • Foley DP, Sasso WR, Ye JY, et al. Twenty-year radiographic outcomes following single-level cervical disc arthroplasty: results from a prospective randomized controlled trial. Spine (Phila Pa 1976). 2024;49(5):295-303. doi:10.1097/BRS.0000000000004888. https://pubmed.ncbi.nlm.nih.gov/38018773
  • Gao F, Mao T, Sun W, et al. An updated meta-analysis comparing artificial cervical disc arthroplasty (CDA) versus anterior cervical discectomy and fusion (ACDF) for the treatment of cervical degenerative disc disease (CDDD). Spine (Phila Pa 1976). 2015;40(23):1816-1823. doi:10.1097/BRS.0000000000001138. https://pubmed.ncbi.nlm.nih.gov/26571063
  • Gutman G, Rosenzweig DH, Golan JD. Surgical treatment of cervical radiculopathy: meta-analysis of randomized controlled trials. Spine (Phila Pa 1976). 2018;43(6):E365-E372. doi:10.1097/BRS.0000000000002324. https://pubmed.ncbi.nlm.nih.gov/28700452
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  • Huang W, Liu S, Cai Z, et al. Comparison of outcomes between cervical disc arthroplasty and anterior cervical discectomy and fusion for the treatment of cervical spondylotic myelopathy: a systematic review and meta-analysis. J Neurosurg Spine. Published online February 9, 2024. doi:10.3171/2023.6.FOCUS23291. https://pubmed.ncbi.nlm.nih.gov/37644726
  • Janssen ME, Zigler JE, Spivak JM, et al. ProDisc-C total disc replacement versus anterior cervical discectomy and fusion for single-level symptomatic cervical disc disease: seven-year follow-up of the prospective randomized U.S. Food and Drug Administration Investigational Device Exemption Study. J Bone Joint Surg Am. 2015;97(21):1738-1747. doi:10.2106/JBJS.N.01186. https://pubmed.ncbi.nlm.nih.gov/26537161
  • Joaquim AF, Makhni MC, Riew KD. Evidence-based use of arthroplasty in cervical degenerative disc disease. Int Orthop. 2019;43(4):767-775. doi:10.1007/s00264-018-04281-y. https://pubmed.ncbi.nlm.nih.gov/30623197
  • Nunley PD, Coric D, Frank KA, Stone MB. Cervical disc arthroplasty: current evidence and real-world application. Neurosurgery. 2018;83(6):1087-1106. doi:10.1093/neuros/nyx579. https://pubmed.ncbi.nlm.nih.gov/29325074
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