Severely painful disc conditions causing neck pain with or without arm pain are classically treated with an operation called anterior cervical discectomy with fusion. This operation is the time-honored solution for painful disc conditions in the neck. Unfortunately, anterior cervical discectomy and fusion (ACDF) has a number of unintended side effects. These include:
• the fusion fails to heal which means a second fusion may be needed
• with two or more vertebra fused (welded) together the patient has a chronic sense of stiffness or heaviness in the neck accompanied by loss of motion.
• this loss of motion leads to difficulties in activities of daily living. Patients often complain of stiffness, fatigue, pain at the base of the neck and a crunching sensation when moving the neck.
• commonly, a plate and screws are used to secure the fusion. Unfortunately, the plate can affect the functioning of the esophagus and lead to difficulties in swallowing. About 47 percent of patients with ACDF have complaints of swallowing on a long term basis (this includes all cases from minor problems to the most severe problems)
• when two vertebra are fused (welded) together, the adjacent disks have to endure added stress leading to early deterioration. On many occasions, the discs next to the fusion will deteriorate requiring additional surgery.
• in order to fuse two or more vertebra together bone graft is needed. This bone graft can come from the patient however, having bone taken from one part of the body and placed in another can be quite painful and at times disabling. Cadaver bone or bone from the bone bank is commonly used however there have been occasions when tainted bone has been inadvertently implanted in patients leading to severe complications.
• smokers tend to have increased difficulty healing of fusion compared to non smokers. With this increased difficulty in healing comes the increased incidence of repeat surgery to get the fusion to heal.
• most patients after spinal fusion will wear a brace for two or three months and have significant restrictions placed upon them so as not to endanger healing of the fusion.

Total disc replacement avoids some of the problems of ACDF in that:
• there is no healing of the bones required precluding the risk of additional surgery
• early motion of the neck is encouraged on the same day of surgery thereby greatly reducing the risk of stiffness and the accompanying complaints of fatigue, pain at the base of the neck and the crunching sensation noted in fusion patients.
• basic science studies in the laboratory show there is no increase stress at the discs next to the disk replacement. Therefore the potential for additional surgery is less than with spinal fusion
• no brace is needed and restrictions are minimal
• swallowing problems from mild to severe are about 15% in disk replacement patients compared to 47% in fusion patients
• there is no difference in results of smokers and non smokers
• no bone graft is harvested, therefore there is no risk of the pain associated with harvesting of bone graft and there is no increased risk of hepatitis or HIV compared to using cadaver bone graft in fusion surgery.