By Mr Ahmed-Ramadan Sadek, Neurosurgeon · Last reviewed October 2026 · 7 min read

What are these operations?

Between each pair of neck vertebrae sits a disc that cushions and spaces the bones. With age discs dry out and bulge, and bony spurs (osteophytes) form at their edges. Pressure on a nerve root causes arm pain, tingling or weakness, known as cervical radiculopathy. Pressure on the spinal cord can cause clumsy hands and unsteady walking: cervical myelopathy.

Both operations reach the spine from the front. The surgeon takes out the whole of the problem disc, together with any spurs, so the nerve or cord has room again.^[1] The difference lies in what fills the empty space afterwards.

ACDF (anterior cervical discectomy and fusion)

Once the disc has been removed, the space is propped open with a small cage, usually made of PEEK (a strong plastic) or titanium and often packed with bone graft or synthetic bone. Over the following 3 to 6 months the vertebrae above and below grow into the graft and become one solid block.^[1] A thin titanium plate is sometimes added, for example when more than two levels are treated or bone healing may be slow.

Cervical disc replacement (arthroplasty)

Here an artificial disc is fitted into the space instead of a cage. BASS describes it as keeping roughly 5 to 8 degrees of bending at that level.^[1] The hope is that keeping movement spares the neighbouring discs extra strain. It suits people with a disc prolapse but no arthritis, osteoporosis or instability. NICE has concluded that the procedure is at least as effective as fusion in the short term, and that it should be done only in specialist units where neck surgery is performed regularly.^[2]

Who is it for?

Most trapped nerves in the neck settle without an operation. BASS says about 6 in 10 people improve by six weeks and 7 to 8 in 10 by three months, which is why surgery is rarely considered before 6 to 8 weeks unless the nerve is clearly struggling.^[1] Painkillers, physiotherapy and image-guided nerve root injections are usually tried first.

An operation is normally offered when arm pain stays severe despite these measures, or when numbness or weakness suggests the nerve is being damaged. Myelopathy is different. Pressure on the cord rarely eases by itself, so the main purpose of surgery is to stop the condition getting worse.^[3]

Front-of-neck surgery is not a treatment for neck ache on its own, and how much neck pain improves afterwards is hard to predict.^[1] For some people with a single trapped nerve, a keyhole operation from the back (posterior foraminotomy) is an alternative; one review found similar complication and reoperation rates to ACDF, though the authors called this preliminary.^[4]

Before the operation

• Tell the team if you take blood thinners such as warfarin, aspirin, clopidogrel or rivaroxaban, or anti-inflammatory painkillers. Some may need stopping beforehand.^[1]
• Nicotine slows bone healing. BASS advises stopping smoking, ideally 2 to 3 months before surgery, and your operation may be postponed if you have not.^[1]
• BASS advises women to stop the combined pill or HRT containing oestrogen four weeks before surgery, to lower the risk of blood clots.
• Arrange for someone to drive you home.

On the day

You are asleep under general anaesthetic, lying on your back. Through a cut a few centimetres long, the windpipe and gullet are eased aside to reach the spine, usually under a microscope. The disc space is gently opened, the disc and spurs are removed, and the cage or artificial disc is placed using X-ray guidance.^[1]

After the operation and recovery

You will wake sitting up, which helps limit swelling in the neck. A small drain is usually taken out the next day, and most people go home the day after surgery.^[1] After operations for myelopathy, a stay of 1 to 2 days is more typical.^[3]

A sore throat, husky voice and feeling of food sticking are common, so stick to soft meals for a few days. Arm symptoms can fluctuate for up to eight weeks or longer as the nerve settles. Reduce strong painkillers and nerve pain medicines such as gabapentin or pregabalin gradually rather than stopping suddenly.^[1]

• Wound: you can shower after 48 hours, keeping the dressing as dry as possible.
• Driving: usually after 2 to 4 weeks, once you can turn your head freely, your arms feel normal and you could make an emergency stop.
• Work: most people take 3 to 4 weeks off; heavy manual jobs may need up to eight weeks.
• Activity: walk often and avoid heavy lifting for the first few weeks, possibly up to three months. Swimming or golf usually resume between six weeks and three months.
• Flying: your surgeon may suggest not flying for six weeks, with long-haul travel delayed for up to three months.^[1]

If you had myelopathy, any gain in hand function or walking is often modest and comes slowly over a year or so.^[3]

Risks and complications

The figures below come from the BASS booklets on surgery for a trapped nerve and for myelopathy.^[1][3] Your surgeon will talk through how they apply to you.

Risk	Approximate frequency (BASS)
Superficial wound infection	Up to 4 in 100
Deep wound infection	Fewer than 1 in 100
Damage to a nerve root	Fewer than 1 in 100 at a first operation; up to 10 in 100 in repeat surgery
Tear in the lining around the nerves (dura), with possible fluid leak	Fewer than 1 in 100 (radiculopathy booklet); fewer than 5 in 100 (myelopathy booklet)
Blood clot in the leg or lung	Fewer than 1 in 100
Cage, graft or artificial disc moving out of place	Up to 2 in 100, with about 1 in 100 needing another operation
Bones failing to fuse (ACDF)	Up to 5 in 100
Injury to the windpipe or gullet	Fewer than 1 in 100
Droopy eyelid from stretching of a small nerve	Fewer than 1 in 100; nearly always recovers
Death from injury to a major blood vessel	About 1 in 10,000
Fatal complication of general anaesthetic	About 1 in 250,000

BASS also lists hoarseness from stretching of the nerve to the voice box (usually temporary) and bleeding in the neck that may need a return to theatre. Spinal cord injury, stroke and heart attack are very rare. In later years, neighbouring discs may wear.^[1]

In a trial of multilevel myelopathy surgery, 41% of people operated from the front had swallowing difficulty, against none operated from the back.^[5] These were larger operations, so this is not the risk for a single level.

What does the evidence show?

For a trapped nerve, BASS puts good relief of arm pain at about 85 to 90%, though it can take weeks and some numbness or weakness may remain.^[1]

A meta-analysis of six studies with ten years of follow-up found fewer further operations and adverse events after disc replacement than ACDF. Pain and disability scores were slightly better, but not by enough for patients to notice, and nerve recovery was similar.^[6] NICE likewise noted that disc replacement may reduce the need for revision surgery in the long term, and asked for more long-term data.^[2]

On the other hand, BASS notes that an artificial disc might wear out like a hip replacement, though there is no evidence yet on when or whether this happens, and a failed disc would probably be converted to a fusion.^[1]

For myelopathy, the trial above found similar physical function one year after front or back surgery.^[5] The approach depends on where the pressure lies and how many levels are involved.

Contact your hospital team or GP if the wound becomes red, leaks or you develop a high temperature, or if swallowing is getting worse.

References

1. British Association of Spine Surgeons. Cervical Disc Protrusion and Radiculopathy: Surgical Options (patient booklet, issue 3). BASS; 2021. Link
2. National Institute for Health and Care Excellence. Prosthetic intervertebral disc replacement in the cervical spine. Interventional procedures guidance IPG341 (now HealthTech guidance HTG217). NICE; 2010. Link
3. British Association of Spine Surgeons. Cervical Stenosis and Myelopathy: Surgical Options (patient booklet, issue 3). BASS; 2021. Link
4. Fang H, Cui M, Zhao K, et al. Minimally invasive posterior cervical foraminotomy versus anterior cervical fusion and arthroplasty: systematic review and updated meta-analysis. Brain Spine. 2024;4:102852. Link
5. Ghogawala Z, Terrin N, Dunbar MR, et al. Effect of ventral vs dorsal spinal surgery on patient-reported physical functioning in patients with cervical spondylotic myelopathy: a randomized clinical trial. JAMA. 2021;325(10):942-951. Link
6. Quinto ES Jr, Paisner ND, Huish EG Jr, Senegor M. Ten-year outcomes of cervical disc arthroplasty versus anterior cervical discectomy and fusion: a systematic review with meta-analysis. Spine (Phila Pa 1976). 2024;49(7):463-469. Link

This guide is general information and is not a substitute for advice about your own situation. Please discuss the benefits and risks of any procedure with your surgeon.