Surgery for neck pain: Cervical Spine Fusion vs. Disc Replacement

Corey J. Wallach, MD, is a fellowship-trained spine surgeon, board-certified in orthopaedic surgery. He serves as the medical director of the Inova Spine Program at Inova Alexandria Hospital and Inova Mount Vernon Hospital.  

If you’ve experienced severe neck pain, you’re not alone. Up to 70% of Americans experience significant neck pain at some point. Everything from sleeping with a new pillow to sitting at your computer all day may cause neck pain.

Most people can relieve neck pain with nonsurgical treatments such as setting up an ergonomic workspace, participating in physical therapy or taking anti-inflammatory medication. But if neck pain lingers for weeks or months without relief, it may be time to see a spine specialist physician for further diagnosis and treatment options. Sometimes, surgery may be the most effective treatment.

Why might I need surgery for neck pain?

You may need surgery if you have damage to the structures in your cervical spine, the portion of your spine that extends through your neck. The most common reasons for neck surgery include:

• Bulging or herniated discs: Between each of the bones in your spinal column (vertebrae), you have a cushion-like pad called a disc. Discs absorb shock and help you move your head and neck smoothly. Each disc has a soft, gel-like center and a tough outer shell. Sometimes, the gel-like center pushes against the outer shell, leading to a bulging disc. If the outer shell tears and the center pushes through it, it’s called a herniated or ruptured disc. The herniated disc can press on surrounding tissue and nerves, causing pain.
• Cervical stenosis: Stenosis occurs when your spinal canal narrows. The narrowing can pinch your spinal nerves, causing radiating pain or numbness (cervical radiculopathy). Stenosis can also compress your spinal cord, causing numbness, weakness or problems with coordination (cervical myelopathy).

Your surgeon may use either a cervical fusion or an artificial disc replacement to treat these conditions. The good news? If you do need surgery, current procedures have excellent success and satisfaction rates. At Inova Health System we have high patient satisfaction rates for both cervical spinal fusion and artificial disc replacement. Here’s what to consider about both options. 

What is the difference between a cervical fusion and a disc replacement?

In a cervical fusion, your provider removes the damaged disc or stenosis and fuses (connects) two or more vertebrae together. In a disc replacement, your provider removes a damaged disc or stenosis, and inserts an artificial one in its place.

What happens during a cervical spinal fusion?

During a cervical spinal fusion, your surgeon releases pressure on surrounding nerves by widening your spinal canal or removing a damaged disc. They then place a bone graft or other structural device in the area and reinforce the graft with plates and screws to keep it in position while your bones heal. Over time, the vertebrae join together (fuse). The procedure is typically done with a surgical microscope and X-ray guidance for precision.

What happens during an artificial disc replacement?

In a disc replacement, your surgeon uses a microscope and X-ray guidance to locate the damaged or diseased disc along with any bony growths (bone spurs). The damaged disc and bone spurs are removed and replaced with an artificial disc. The surrounding vertebrae don’t fuse during healing to maintain more range of motion in the spine.

Why choose a cervical spinal fusion vs. an artificial disc replacement?   

Both a spinal fusion and a disc replacement effectively treat neck pain in many patients. The procedure that’s right for you depends on your age, specific condition, overall health and lifestyle.

Healthy patients in their 30s or 40s who don’t have significant wear and tear of their spine are typically good candidates for either procedure. Older patients or those with severe arthritis are typically better candidates for a cervical spinal fusion. 

Your lifestyle and goals can also affect which surgery option is better for you. For example, if you participate in high-contact sports such as football or mixed martial arts, the stability of a spinal fusion may be a better choice for you.

What to expect during recovery from neck surgery

At Inova Health System, most of our patients return home the same day or the day after cervical spine surgery. For the first few days, you may have some mild difficulty swallowing, but typically only require a brief course of pain medications. You’ll likely wear a soft immobilization collar for a few weeks while your incision heals.

Most people feel comfortable and return to desk jobs around three weeks after surgery, when they are also cleared to drive. Most gradually returning to recreational activities as well. You’ll probably be back to your usual activities at around the two-month mark. If you have a labor-intensive job, though, you may need to wait three months before returning to work without limitations.

We often recommend physical therapy after spine surgery. Learning proper stretching and strengthening exercises can help with your recovery and decrease your risk of future neck injuries or pain.

Schedule an appointment with the Inova Spine Program

The right surgery for you depends on multiple factors, including your age, activity levels and overall health. One of our spine specialists can help you understand whether cervical spinal fusion or artificial disc replacement is the right treatment option for your neck pain.

Experiencing back or neck pain? The Inova Spine Program can help. Our interdisciplinary specialists are experts in diagnosing and treating back pain with surgical and nonsurgical options.

There’s no one-size-fits-all approach to relieving back or neck pain. We work with you to create a customized, effective treatment plan. Read more about the Inova Spine Program or call 703-776-4700 to find out how we can help.