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The cervical spine is the top portion of the spine, spanning from the base of the head to where the neck meets the back. The spine is made up of small bones (vertebrae) connected by rubbery disks and the spinal cord, which carries nerves between your brain and the rest of your body.

Illustration showing the three segments of the spine. The cervical spine is the top portion, spanning from the base of the head to where the neck meets the back

Over time or with injury, the disks can wear down (degenerate) and change shape, putting pressure on the nearby nerves. This is typically pressure on either:

• The spinal cord itself (myelopathy)
• Nerves as they leave the spinal cord (radiculopathy)

This pressure can cause stiffness, shooting pain, weakness, and other symptoms.

Your doctor, guided by a physical exam and diagnostic imaging, will determine if your neck pain is being caused by a problematic (arthritic) disk. If it is, your doctor will work with you to manage pain using conservative (nonsurgical) treatments like medications, injections, and/or physical therapy.

Surgery may be considered if you are still having pain after trying conservative treatments. However, not everyone who continues to experience pain after exhausting nonsurgical treatments is a good candidate for surgery.

The two most common surgical options for problematic disks are:

• Cervical spinal fusion
• Cervical disk replacement

Cervical disk replacement allows for more normal movement of the neck compared to cervical spinal fusion, which connects the bones above and below the problematic disk to prevent painful movement.

To determine whether you are a good candidate for disk replacement, your surgeon may require a few tests, including:

• Magnetic resonance imaging (MRI) scans
• Discography
• Computed tomography (CT) scans
• X-rays

Information from these tests will also help your surgeon confirm the source of your symptoms.

Artificial disk replacement is not appropriate for all patients. In general, good candidates for disk replacement have the following characteristics:

• Pain caused by one or two problematic (arthritic) intervertebral disks in the cervical spine
• No significant facet joint disease or bony compression on spinal nerves
• Body size that is not excessively overweight
• No prior major surgery on the neck
• No deformity of the spine (scoliosis)
• No weak bones (osteoporosis)
• No instability in the spine

Before your surgery:

• Your surgeon will review medications, vitamins, and herbal supplements you take at home. You may have to stop taking certain medications for a period of time before your surgery.
• If you smoke, your surgeon may talk to you about stopping smoking in preparation for the surgery and afterward as it negatively affects surgical success and the recovery process.
• You will likely be given instructions to stop eating and drinking the night before the surgery.

Most artificial disk replacement surgeries take 2 to 3 hours. You will be given general anesthesia to keep you asleep during the procedure.

Before the surgery, the surgical team will place an intravenous (IV) line to give you fluids and medication to keep you asleep.

During the surgery, your surgeon will:

• Make an incision in the front of you neck on your neck crease.
• Move blood vessels and other important structures to the side to get to the disk space.
• Remove your problematic disk and insert an artificial disk in its place. Your surgeon will use imaging throughout the surgery to see the vertebrae better and position the artificial disk properly.
• Once the procedure is complete, close the incision and place bandages over it to protect it from contamination.

An intervertebral disk is made up of two main parts: an inner part called the nucleus, and an outer ring called the annulus.

In most cervical disk replacements, the entire disk will be removed and replaced with an artificial disk.

Artificial disk replacement initially gained FDA approval for use in the U.S. in 2004. Since then, numerous disk replacement designs have been developed, and more are currently being tested.

Each disk design unique in its own way, but all maintain a similar goal: to reproduce the size and function of a normal intervertebral disk.

Some disks are made of metal, while others are a combination of metal and plastic, similar to joint replacements in the knee and hip. Materials used include medical grade plastic (polyethylene) and medical grade cobalt chromium or titanium alloy.

Your surgeon will talk with you about which disk design is best for you.

In most cases, you will stay in the hospital for 1 to 2 days after artificial disk replacement. In some cases, you may be able to go home that day. The length of your stay will depend on:

• How well-controlled your pain is 
• Your return to function
• The details of the procedure you had

You will be given instructions from your doctor on medications to take to relieve pain and how to take care of your incision site at the hospital and at home.

• As you recover, excessive motion should be limited because your bone has to heal to the artificial disk. Your doctor may have you wear a protective neck brace for the initial recovery.
• You may find it temporarily difficult to swallow for a few days after surgery.
• Most patients are able to return to driving and desk jobs within 1 to 2 weeks.
• Returning to strenuous jobs usually takes 6 to 12 weeks.

Most patients can expect improvement of pain and disability in weeks to months following surgery. Studies show that disk replacement improves but does not completely eliminate pain. Before your surgery, it is important to talk to your surgeon about realistic expectations for pain relief.