Patients who are considering spine surgery have two choices, CADR vs ACDF. These are the most effective cervical spine surgeries available, but some patients are better candidates for one over the other. Learn which procedure is right for you.
Anterior Cervical Discectomy and Fusion, also known as ACDF, is a spine surgery procedure in which a spine surgeon makes an incision in the front (anterior) of the neck and removes a diseased vertebral disc. Next, the vertebral bones above and below the extracted disc are fused together with bone grafts or other materials. Once the vertebral bones are healed, they are solidly fused together and move as one larger bone.
Cervical Artificial Disc Replacement or Cervical ADR is also a spine surgery procedure in which a spine surgeon makes an anterior incision and removes a diseased vertebral disc. However, instead of fusing the vertebral bones together, in Cervical ADR, the spine surgeon places an artificial cervical disc where the diseased disc once was.
Use this guide to compare Anterior Cervical Discectomy and Fusion vs Cervical Artificial Disc Replacement.
While we will discuss more differences between cervical disc replacement vs fusion below, the main difference is neck mobility. In ACDF, the vertebral bones are fused and the neck is less mobile after healing. In Cervical ADR, i.e., cervical disc replacement, the vertebral bones remain apart, separated by an artificial vertebral disc. This allows the neck to bend, flex, and rotate more naturally after Cervical ADR.
Dr. Lanman has been a part of a 10-year study comparing cervical disc replacement vs fusion based on clinical criteria, namely pain complaint, post-operative revisions, flexibility and movement, and other factors. Artificial disc replacement was found to reduce the likelihood of another surgery by more than 50%. Cervical artificial disc replacement statistically received superior outcomes compared to fusion including for:
CADR is best for patients who want to find relief from chronic neck pain and to maintain neck flexibility.
Cervical Artificial Disc Replacement is a procedure performed by a spine surgeon while the patient is under general anesthesia. The spine surgeon makes an incision in the front of the neck, just off-center, carefully avoiding the important structures in the neck. The surgeon identifies the diseased vertebral disc and removes it. The bone is prepared (decorticated) and any bone spurs (osteophytes) are smoothed.
The spine surgeon places an artificial disc in the space where the damaged disc just was. Placement has to be done precisely to make sure the artificial disc is in proper alignment in all three dimensions. Once in place, the artificial cervical disc is held in place but the two vertebral bones, one above and one below the new disc.
Once the artificial cervical disc is in place, the incision in the neck is closed and healing can begin. Since the vertebral bones don’t need to fuse together after Cervical Artificial Disc Replacement, the recovery process is usually easier and faster than it is with spinal fusion surgery.
Like Cervical ADR, Anterior Cervical Discectomy and Fusion is a procedure performed by a spine surgeon while the patient is under general anesthesia. An incision is made in the neck as it is with replacement, and the damaged disc is carefully and completely removed.
The goal of vertebral fusion is to create a single bone out of two bones—the cervical vertebral bones above and below the diseased disc. To accomplish this, the spine surgeon may take a small piece of bone from another place in the patient’s body, usually the iliac crest of the pelvis in the hip area. Alternatively, donor bone from a cadaver or synthetic bone material may be used instead of the patient’s bone. Another option is to use a cervical cage that is filled with small pieces of bone or bone-like material.
This little bit of bone or synthetic bone material is then placed in the space where the damaged vertebral disc once was. The vertebral bones do not fuse immediately; just as an arm or leg fracture takes time to heal, so too do the vertebral bones take time to knit and fuse together. Thus, the vertebral bones will likely be held together with metal hardware (e.g. plates and screws, rods and screws, etc.) to allow the new bone to heal and solidify. This incision in the neck (and the incision in the hip, if a bone graft was taken) is closed with sutures.
ACDF is best for patients who want relief from chronic neck pain and have facet joint degeneration, poor bone quality, or cancer.
Patients who are considering spine surgery for chronic neck pain should carefully compare CADR vs ACDF.
Most people can expect the following positive outcomes after ACDF:
On the other hand, ACDF has the following drawbacks:
People who are considering Anterior Cervical Discectomy and Fusion should also consider Cervical Artificial Disc Replacement because it is superior to ACDF in some key areas.
Most people can expect the following positive outcomes after Cervical ADR:
On the other hand, Cervical ADR has the following drawbacks:
The first step in determining whether ADR or ACDF is right for you is to determine if you are a candidate for Cervical ADR. To do that, you should choose a spine surgeon who is an expert in both ADR and ACDF procedures. These specialists will objectively evaluate your unique clinical situation and help you decide which surgery is right for you.
Most people with chronic neck pain who have failed to achieve relief from medical treatment and physical therapy will be eligible for either Cervical ADR or ACDF. However, some people will not be candidates for ADR and will instead only be able to have fusion surgery. Some possible reasons that ADR may not be possible are if that patient has ankylosing spondylitis, bone cancer, infection, or osteoporosis.
If you are a candidate for Cervical Artificial Disc Replacement and would like to preserve motion in your neck after surgery and have a faster recovery, you should speak with a spine surgeon who has deep expertise in both ADR and ACDF. Cervical Artificial Disc Replacement is often the superior choice (cervical disc replacement vs fusion) in those who are eligible.