From the Guidelines
No, ACDF surgery is not the same as disc replacement, as ACDF involves fusion of the vertebrae, while disc replacement preserves motion at the affected level. The key difference between these two procedures lies in their approach to addressing damaged discs: ACDF removes the damaged disc and fuses the vertebrae together with bone graft material and often metal hardware, eliminating motion at that segment 1. In contrast, disc replacement removes the damaged disc but replaces it with an artificial device designed to maintain motion at that level. This distinction is crucial because ACDF may lead to increased stress on adjacent discs over time, potentially causing adjacent segment disease, while disc replacement aims to maintain more normal neck biomechanics.
Some of the key benefits of disc replacement over ACDF include improved pain and patient satisfaction, reduced reoperation rate and operation time, shortened duration of hospital admission, and decreased post-surgical complications, as shown in recent reviews comparing lumbar spine fusion with total disc replacement 1. The choice between these procedures depends on specific factors, including the patient's age, overall spine health, number of levels affected, and the surgeon's recommendation based on the individual case.
When considering the outcomes of these procedures, it's essential to prioritize morbidity, mortality, and quality of life. Recent evidence suggests that total disc replacement may offer advantages over lumbar spine fusion in terms of reduced complications and improved patient outcomes 1. However, the decision between ACDF and disc replacement should be made on a case-by-case basis, taking into account the unique needs and circumstances of each patient. The goal of treatment should always be to minimize morbidity, mortality, and improve quality of life, and the choice of procedure should be guided by the most recent and highest-quality evidence available 1.
From the Research
Comparison of ACDF and Disc Replacement
- ACDF (Anterior Cervical Discectomy and Fusion) and disc replacement are two different surgical procedures used to treat cervical degenerative disc disease 2, 3, 4, 5, 6.
- ACDF involves the removal of the disc and fusion of the adjacent vertebrae, while disc replacement involves the implantation of an artificial disc to preserve motion and reduce the risk of adjacent segment disease 2, 4, 5, 6.
- Studies have shown that disc replacement can preserve cervical spine segmental motion and reduce the risk of adjacent segment disease, while ACDF can result in a loss of motion and increased risk of adjacent segment disease 2, 4, 5, 6.
Clinical Outcomes
- Clinical outcomes, such as pain reduction and neurological success, have been shown to be similar between ACDF and disc replacement in some studies 2, 4, 5, 6.
- However, other studies have found that disc replacement can result in better clinical outcomes, such as improved Neck Disability Index scores and reduced rates of secondary surgery 4, 5, 6.
- The incidence of adverse events, such as dysphagia and dysphonia, has been shown to be lower in disc replacement compared to ACDF 4, 6.
Long-Term Outcomes
- Long-term outcomes, up to 10 years, have been reported in some studies, showing that disc replacement can result in improved clinical outcomes and reduced rates of revision surgery compared to ACDF 6.
- The preservation of motion and reduction of adjacent segment disease with disc replacement may contribute to the improved long-term outcomes 2, 4, 5, 6.