Cervical Disk Arthroplasty (CDA): Everything You Need to Know

Spine surgery


Cervical disk arthroplasty (CDA, also known as artificial disk replacement, or ADR) is a surgical procedure to relieve pressure on the spinal cord and/or nerve roots by replacing a degenerated disk with an artificial replacement. In contrast to a spinal fusion, this preserves some degree of motion between the diseased spinal segment.

Disk arthroplasty is used to treat a variety of spinal conditions affecting the neck including spinal stenosis and cervical radiculopathy.

The surgery is performed under general anesthesia and can take a few hours to complete. Recovery time can vary, but typically takes several weeks to months.

What is a disk arthroplasty?

Cervical disk arthroplasty is a type of surgical procedure that is performed to relieve pressure on the spinal cord and/or nerve roots in the neck caused by degeneration of an intervertebral disk. This involves removing a damaged or herniated disc from between two vertebrae in the neck and replacing it with a device designed to preserve some motion properties of the segment. 

During the surgery, a small incision is made in the front of the neck to access the cervical spine. The surgeon then removes the damaged disc and any bone spurs or other tissue that may be compressing the spinal cord or nerve roots. Finally, an arthroplasty device is implanted to replace the removed disk.

Which conditions are treated with arthroplasty?

Some of the conditions that may be treated with ADR surgery include:

  • Disc herniation: A herniated disc occurs when the soft material inside a spinal disc bulges out through a tear in the disc’s outer layer, putting pressure on the spinal cord or nerve roots.
  • Spinal stenosis: Spinal stenosis is a narrowing of the spinal canal that can put pressure on the spinal cord or nerve roots.
  • Cervical radiculopathy: Cervical radiculopathy is a condition that occurs when the nerves in the neck become compressed or damaged, leading to pain, numbness, tingling, or weakness in the arms or hands.

Disk arthroplasty is typically recommended for patients who have not responded to non-surgical treatments such as physical therapy, medication, or injections

What can be expected the day of surgery?

On the day of disk arthroplasty surgery, you can typically expect something like this:

  1. Pre-operative preparations: Before the surgery, you will be asked to change into a hospital gown and to remove any jewelry, contact lenses, or dentures. You may also receive an IV to deliver fluids and medications, and you may be given a mild sedative to help you relax.
  2. Anesthesia: Surgery is performed under general anesthesia, which means you will be asleep during the procedure.
  3. Surgery: Once you are under anesthesia, the surgeon will make a small incision in the front of your neck to access the cervical spine. The damaged disc will then be removed and replaced with an arthroplasty device.
  4. Post-operative recovery: After the surgery is complete, you will be taken to a recovery room to be monitored as you wake up from anesthesia. You may have a small temporary drain in your incision site to help prevent fluid buildup, and you may also have a cervical collar or brace to support your neck during the healing process.
  5. Hospital stay: Most patients go home the very same day of surgery. Others may have a short hospital stay.

What is the recovery time following arthroplasty surgery?

The recovery time after disk arthroplasty can vary depending on several factors, including the extent of the surgery, the patient’s overall health, and their ability to follow their post-operative instructions. 

However, below is a general timeline of what patients can expect during their recovery

Hospital stay

Most patients can go home the very same day. Others (such as those with pre-existing medical conditions) may spend a short amount of time in the hospital.

Rest and limited activity

Patients are typically advised to rest and limit their activity for the first few weeks after the surgery, as the interface between the vertebral bone and arthroplasty device matures. Patients may need to wear a cervical collar or brace to support their neck during this time.

Physical activity

After the first few weeks, patients may begin physical therapy to help restore strength, flexibility, and range of motion to the neck and spine. This typically begins after the first postoperative visit, so your surgeon can ensure you’ve healed enough for physical therapy. Physical therapy may continue for several weeks or months, depending on the patient’s progress.

Return to work and normal activities

Patients may be able to return to work and resume normal activities after several weeks, depending on the type of work and the level of physical activity involved.

What are the risks of disc arthroplasty?

As with any complex operation, there are several risks associated with disk arthroplasty surgery. Some of these risks include:

  • Infection: Although surgery is performed in sterile conditions, there is always a small risk of infection
  • Nerve damage: Nerves in and around the spinal cord can be damaged during the surgery.
  • Damage to other surrounding tissues: Other tissues as well as blood vessels and can be damaged during the procedure
  • Adjacent segment disease: Adjacent segment disease can occur when the segments of the spine above or below the instrumented area become damaged or degenerate.
  • Hardware complications: The arthroplasty device may become misaligned, loosen, or fail for different reasons. Such an event may require additional surgery including conversion to ACDF.

Is a disk arthroplasty right for me?

Cervical disk arthroplasty is usually recommended after non-surgical treatments such as physical therapy, medications, or injections have failed to relieve your symptoms.

Data continues to emerge about which patients respond best to cervical disk arthroplasty or fusion. One theory is that the technique is best reserved for younger patients with relatively isolated disk degeneration. It is a newer technique compared to discectomy & fusion (ACDF) and carries a slightly different risk profile. 

There are several factors that your doctor will consider when determining if disk arthroplasty is the right choice for you, including your age, the relative health of nearby spinal segments, and the potential risks and benefits of the surgery. 

It is important to have a thorough discussion with your doctor, as they can provide you with more detailed information about the procedure and help you determine if it is the right choice for you.

About the Author

TJ Florence

Dr. Florence is a neurosurgery resident at UCLA. He earned MD and PhD degrees from Columbia College of Physicians & Surgeons as part of the Medical Scientist Training Program after college at the University of Southern California. Outside of the OR, he works on improving precision in neuronavigational systems, understanding the biology of the degenerating spine, and describing refinement of new surgical techniques.