Neck pain can be funny (funny weird, not funny-ha-ha). If you actually feel it in your neck, it’s probably a muscle strain—aka, not very serious. If, instead, you feel numbness, tingling, weakness or straight-up agony in one of your arms, you might have a more serious neck problem that’s causing radiculopathy—radiating pain. And when you have radiculopathy, you’ll do almost anything to get rid of it.
If your pain hasn’t gone away within about six weeks, it’s time to see the doctor. And if you try the conservative treatments that your doctor will recommend (activity modification, physical therapy, anti-inflammatories) without success, it may be time to bring out the big guns. That usually means one of two surgical procedures: Anterior cervical discectomy and fusion (ACDF), or cervical disc replacement.
The whole goal for these surgeries initially is to take the pressure off a nerve root or, less commonly, the spinal cord, says Rahul Shah, MD, board certified orthopedic spine and neck surgeon with Premier Orthopaedic Spine Associates. Which one is right for you? That depends, he says, on your individual needs and your medical history. But if you want to know how these procedures are similar to and different from each other, you’ve come to the right place.
ACDF has been around since the 1950s and it’s the most common cervical spine operation performed in the U.S., estimated at about 137,000 operations per year. It’s considered the gold-standard surgery for cervical disc degeneration. “Anterior cervical discectomy and fusion” is a mouthful, so let’s break down what each of those words means:
The bone graft inserted in the space may be done using autograft (taken from the patient’s hip) or allograft (the bone comes from other sources), and it allows the bone to set up a bridge or fusion between the bones of the spine. The fusion component means a bone graft will grow together with the vertebrae. The goal with fusion is to eliminate potentially painful movement. (Related: When to Call the Doctor with Back Pain)
Cervical disc replacement surgery is similar to ACDF in that the damaged disc will be removed, but now an artificial disc is put in its place. Your doctor also might refer to this surgery as anterior disc replacement or cervical disc arthroplasty. The goal here is not fusion; rather, the arthroplasty device helps retain the neck’s normal range of motion.
If the problem is relegated to just the disc and it’s only one or two discs, then either the cervical disc replacement or a fusion can work to maintain that disc space once you’ve removed the disc, says Dr. Shah. ACDF and anterior disc replacement both are surgery in the front of the neck.
“The challenge is that wherever we have movements, anything that moves can fail or can wear out,” he says. “So wherever that wearing out occurs and there’s pressure on the nerves, oftentimes this cervical surgery is performed and the thing that’s causing pressure on the nerve has been removed.”
First described in 1966, disc replacement came into wider use in the early 2000s and has gone through multiple generations using different technologies, different mobile-bearing surfaces, and different polymers, says Dr. Shah.
There are multiple ways of maintaining that space once the disc is removed. “We used to use the patients’ hip bones, then we shifted over to using donated bone from bone banks, now some people use plastic cages, metal cages, some put an artificial plate on, and others don’t put a plate on the metal cage,” Dr. Shah says.
With disc replacement, the artificial disc has to attach to bone to be able to work, because it needs two edges to be able to swivel off of, explains Dr. Shah. You’re putting a hinge in the front of the neck to allow it to maintain its motion.
Some experts and literature say that disc replacement may be better for younger people because it preserves motion and it helps prevent other areas of the spine from wearing out. But, we’re finding other discs can still wear out with cervical disc replacement surgery, Dr. Shah says.
For all intents and purposes, ACDF and disc replacement are the same surgery. The only difference—and admittedly it’s a big one—is that surgeons implant a bone graft in ACDF so the vertebrae fuse together and stop painful movement. In a disc replacement, they implant an artificial disc to preserve the movement of the vertebrae.
“The artificial discs do preserve motion, but the question of ‘do they necessarily work to prevent unintended consequences of other discs wearing out,’ — the answer is not yet clear,” says Dr. Shah. “The number of people that qualify for disc replacement is going to be less than the number of people that qualify for fusion.”
Read the full article on Spine Universe.
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