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Begin with root or cord involvement

The purpose of cervical surgery may be to relieve a root problem, decompress a compromised spinal cord, or address both. Arm pain from a root, axial neck pain and functional myelopathy are different targets. Established moderate/severe DCM has a strong surgery recommendation in the AO Spine/CSRS guideline; mild DCM requires a separate discussion. An operation cannot guarantee reversal of every longstanding neurological symptom.1

New walking difficulty, sudden coordination loss or bladder/bowel control changes with concerning neck or limb symptoms can be emergencies. Use local emergency services. New or progressive substantial weakness needs urgent assessment, not an elective travel or booking plan.23

Three procedure families

Anterior cervical discectomy and fusion (ACDF) approaches the disc from the front, decompresses the target and fuses the treated segment. Disc replacement, or arthroplasty, uses an implant intended to preserve motion in appropriately selected anatomy. Posterior foraminotomy approaches from the back to open a nerve-root exit in selected disease. They are not interchangeable choices based only on a scan label.45

FACET studied adults with single-level, one-sided radiculopathy caused by foraminal narrowing and/or herniation. Pure axial neck pain and myelopathy were excluded. At two years, posterior foraminotomy met the specified 10% noninferiority margin for success and arm-pain outcomes compared with ACDF. Serious surgery-related events and reoperations occurred in both groups. The result cannot decide all multilevel or cord-compression operations.4

Replacement evidence is device and population specific

A primary ten-year Mobi-C trial continuation at three centers reported favorable composite and subsequent-surgery outcomes compared with ACDF in selected one/two-level symptomatic degeneration. It retained losses to follow-up and a selected center subset. It does not establish that every replacement implant is superior, that preserving motion prevents all adjacent-level disease, or that replacement suits every person.5

Eligibility and risk assessment need the actual anatomy, stability, bone health and procedure/device criteria. MRI safety is implant-specific: the treating team and the exact device documentation must establish conditions, rather than a blanket statement about replacement or fusion.

Harms, recovery and expectations

Procedure discussions should cover swallowing problems with anterior approaches, infection, nerve or cord injury, persistent symptoms, implant/fusion problems and possible later surgery as relevant to the option. FACET's complications comparison applies to its procedures and population; replacement risk cannot be inferred from that trial.46

The 2026 mild-DCM critical review emphasizes conditional evidence and counseling that sensory deficits can remain after decompression. It does not turn MRI parameters into a reliable timing tool.7 Ask what the operation aims to improve, what may remain, how complications are recorded and who will oversee follow-up. Return to work, driving, sport or travel requires a personal plan, not a universal date from a procedure comparison.

References

  1. Fehlings MG et al. AO Spine/CSRS DCM guideline. Global Spine J. 2017;7(Suppl):70S–83S. Source ↩
  2. NHS. Cervical spondylosis: symptoms, urgent assessment and treatment. Source ↩
  3. NICE. NG127: Suspected neurological conditions. Adult recommendations 1.7 and 1.10. Source ↩
  4. Simões de Souza NF et al. Two-year FACET randomized noninferiority study. J Bone Joint Surg Am. 2024;106:1653–1663. PubMed ↩
  5. Nunley PD et al. Mobi-C versus ACDF at 10 years: randomized trial continuation at 3 sites. Int J Spine Surg. 2023;17:230–240. DOI ↩
  6. Fehlings MG et al. AO Spine DCM critical review and recommendations. Global Spine J. 2025. doi:10.1177/21925682251331050. Source ↩
  7. Neal CJ et al. Mild DCM: contemporary concepts. Global Spine J. 2026 (online September 24). doi:10.1177/21925682261492222. PubMed ↩