I’m debating whether to have a neck fusion or go for the newer disc replacement. I have a broken down disc at C56. I understand the disc replacement devices have only been around for 10 years or so. What do you recommend?

As you have discovered, patients with painful, unstable necks from degenerative disease have two surgical options when conservative (nonoperative) care fails to help. The first is still considered the gold standard (preferred choice): anterior cervical discectomy and fusion or ACDF. The second is a total disc arthroplasty or disc replacement. And as you said, disc implants have been around for about 10 years now. That means we are starting to get some study results with long-term outcomes.

In a recent report, the five-year results were provided for patients who were in a two-part study using one particular disc implant (the ProDisc-C). Spine surgeons from 13 different centers randomly placed patients with single-level painful disc degeneration into one of two groups. Group one had the anterior cervical discectomy and fusion (ACDF) and group two received the disc implant. The first report came out after two years. Now we have the five-year results.

At the end of two years, it was reported that the ProDisc-C implant was equal to cervical (neck) fusion in terms of pain relief and function. After five years, patients in both groups continued to report high levels of satisfaction. There have been no failures of the ProDisc-C implants so far.

The two significant findings showing the disc implant superior to fusion include: 1) patients with the ProDisc-C have less neck pain (less intense and less often) compared with patients in the fusion group and 2) the reoperation rate is lower among patients with the implant. All other measures (e.g., complications, failures, X-ray results of bone bridging) were equal between the two groups.

The authors conclude that the ProDisc-C implant provides just as good, if not better, results compared with the “gold standard” of spine fusion. Certainly, the disc implant group did no worse than the fusion group. And these results were fairly comparable with reports of studies investigating the two other types of implants currently on the market.

The surgeons say they expect in time that the value and benefit of disc replacement will be proven. They predict better outcomes for cervical disc replacement compared with ACDF with better motion and less chance of developing adjacent segment disease. And the risk of reoperation will remain significantly lower compared with neck fusion.

We hope this information helps when you talk with your surgeon. He or she is really the best one to advise you concerning your best option. Many patient and surgeon factors come into play when making this decision (e.g., your age, your general health, the overall condition of your spine, the condition of your bones, surgeon preference and experience).