The human spine is made up of 33 “motion segments” divided into the cervical, thoracic, lumbar and sacral areas. Motion-preserving surgery aims to keep these segments flexible.
If you have been told you need spinal fusion surgery, you may have other options. Motion-preserving spine surgery treats the source of your neck or back pain while keeping your spine flexible — without permanently locking vertebrae together.
Spinal fusion solves the immediate problem but eliminates motion at the treated segment forever. Over time, this places added stress on the discs above and below the fusion — a well-documented process called adjacent segment disease — which can require additional surgery years later. Motion-preserving procedures are designed to avoid this cascade entirely.
Dr. Ehsan Saadat, a Harvard and Emory-trained orthopaedic spine surgeon at Cedars-Sinai Medical Center, specializes in both cervical and lumbar motion-preserving techniques. Below is an overview of the most common procedures, who qualifies, and how they compare to traditional fusion.
Motion-preserving spine surgery refers generally to surgical options for the cervical and lumbar spine where a traditional fusion is avoided, and the natural motion of the spine is preserved.
Key Points
Motion-preserving spine surgery is designed to relieve neck or back pain while keeping the spine flexible, offering an alternative to fusion for carefully selected patients.
Cervical disc replacement and posterior cervical laminoplasty are two common motion-sparing options, helping decompress nerves or the spinal cord without permanently locking spinal segments together.
Preserving motion may help reduce stress on nearby discs, lowering the risk of adjacent segment disease and future disc degeneration compared with traditional fusion.
Not every patient is a candidate, especially those with severe arthritis, instability, deformity, osteoporosis, or multi-level disease, making a personalized spine evaluation essential.
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The 2 Most Common Motion-Sparing Cervical Spine Surgery Options
There are two types of motion-preserving surgery that surgeons utilize for the cervical spine. The first, cervical disc replacement, is for discs compressing on nerve roots. This type of surgery may also include a spinal fusion. However, the second, known as a posterior cervical laminoplasty, that widens the spinal canal and doesn’t require a fusion. Here’s an overview of both procedures, how they work, and what recovery looks like.
1. Cervical disc replacement
One of the traditional, and widely accepted, techniques in addressing cervical disc degeneration and stenosis is an anterior cervical discectomy and fusion (ACDF) operation.
In this operation, the surgeon removes the degenerative disc causing spinal cord or nerve root compression. They also perform a fusion, which involves placing bone graft and/or implants in the disc’s original spot for stability.
A fusion operation renders the segment stiff and reduces the spinal motion. One of the observed consequences of a cervical fusion operation is that, over time, the adjacent discs can break down, causing new compression on the spinal cord or the nerve roots.
A disc replacement operation, on the other hand, can effectively remove the degenerative disc that is causing spinal cord or nerve root compression, while preserving the motion of the spinal segment. This, in turn, eliminates additional demand from the other discs in the cervical spine. Moreover, it can reduce the risk of future disc breakdown at the other healthy discs.
Also, a cervical disc replacement eliminates the potential issues associated with the need for a bone graft for spinal fusion and allows for early postoperative neck motion. In fact, most surgeons perform cervical disc replacements on an outpatient basis. This means patients often return home the same day or after a one-night stay in the hospital.
Limitations for arthritis
It is important to remember that a disc replacement is a motion-preservation procedure and not a motion-creation procedure.
This means that a severely arthritic segment that did not move before disc replacement is not likely to move after disc replacement. In fact, for patients with severe facet arthritis and neck pain in addition to arm pain, an anterior cervical discectomy and fusion might be a more suitable surgical option.
RELATED: Lower Back Pain: Is Artificial Disc Replacement an Effective Treatment Option?
2. Posterior cervical laminoplasty
A laminoplasty is a surgical procedure that enlarges the spinal canal.
For patients with severe spinal cord compression at multiple levels, who also have normal neck alignment and minimal neck pain, a laminoplasty offers a motion-sparing technique for spinal cord decompression. Similar to the lumbar spine, the “lamina” creates a rigid “roof” over the spinal canal.
During a laminoplasty, the surgeon creates a hinge on one side of the lamina, and wedges open the other side with the aid of a small metallic plate.
This creates more room for the spinal cord without necessitating a fusion. Most patients will notice immediate relief of arm pain and some improvement in hand numbness. Patients also usually need a one or two-night hospital stay prior to going home.
It is important to work on strengthening the muscles of the back of the neck after a laminoplasty, including isometric cervical extensor strengthening.
What Are the Benefits of Motion-Preserving Spine Surgery?
While every case is different, many patients experience a variety of benefits following a motion-preserving procedure. This includes:
- Less pain,
- Spared range of motion,
- Maintained flexibility,
- Short recovery time, and
- Reduced risk of further disc degeneration.
The major benefit of motion-sparing surgeries is that they help prevent future issues with other discs. This means less risk of needing further spine surgery, which is a common consequence of spinal fusions. In addition, procedures like cervical disc replacement are minimally invasive meaning a lower overall risk of complications.
Who Is a Candidate for Motion Preserving Spine Surgery?
Not every patient with back or neck issues is a candidate for motion preserving spine surgery, but for the right individuals, it offers a compelling alternative to traditional spinal fusion. This approach is designed to relieve pain and pressure on the spinal cord or nerves without eliminating movement at the affected segment of the spine.
Ideal Candidates for Motion-Preserving Surgery
Patients who may qualify typically share the following characteristics:
- Single-level disc problems in the cervical (neck) or lumbar (lower back) spine, such as degenerative disc disease or herniated discs;
- Minimal to no spinal instability, meaning the spine maintains its alignment and doesn’t shift excessively with movement;
- No significant facet joint arthritis, as this can interfere with the success of artificial disc placement;
- Good overall bone quality, making it easier to anchor motion-preserving devices effectively; and
- No prior fusion at the level being treated, since fusion changes spinal mechanics in a way that can disqualify a patient from motion preservation surgery.
Who Might Not Be a Good Fit?
Patients with severe spinal deformities, multiple-level disc disease, advanced arthritis, osteoporosis, or significant spinal instability may be better served by other surgical approaches, such as spinal fusion. Additionally, those who have had previous surgeries at the intended level of treatment might not qualify.
In summary, motion preserving spine surgery is best suited for patients with localized spinal disc problems who want to maintain natural movement and avoid the long-term risks of spinal fusion. A thorough evaluation including imaging studies and physical examination is essential to determine whether you’re a good candidate.
Discuss Motion-Preserving Back Surgery Options with Dr. Ehsan Saadat
For those who suffer from neck or back pain, preserving the flexibility of their spine is often a major concern. If this sounds like you, make sure to select a surgeon that prioritizes safety, comfort, and innovative techniques. Dr. Ehsan Saadat is a board-certified, Harvard and Emory-trained orthopaedic spine surgeon, and an Assistant Professor of Orthopaedic Surgery at Cedars-Sinai Medical Center. Him and his team at Saadat Spine are dedicated to the helping patients through the art and science of spinal surgery.
Request a consultation online or give us a call at 310-961-9820
Frequently Asked Questions About Motion-Preserving Spine Surgery
Is motion-preserving surgery safer than spinal fusion?
Neither approach is categorically “safer” — the right procedure depends entirely on your anatomy, diagnosis, and surgical goals. Motion-preserving procedures generally carry a lower long-term risk of adjacent segment disease, and many are performed on an outpatient basis. However, fusion remains the appropriate choice for patients with instability, deformity, or multi-level disease. Dr. Saadat evaluates each patient individually to recommend the best option.
How long is recovery from cervical disc replacement?
Most patients undergoing cervical disc replacement are treated on an outpatient basis and return home the same day or after a one-night stay. Many patients notice improvement in arm pain and numbness quickly. Full return to normal activity varies depending on the level treated and individual healing, but is generally faster than recovery from a multilevel fusion.
Can I have motion-preserving surgery if I have arthritis?
Significant facet joint arthritis at the affected level is generally a contraindication for artificial disc replacement, because the procedure preserves motion — and a severely arthritic segment that was not moving before surgery is unlikely to move after. For patients with significant arthritis, fusion may be the more appropriate option. Dr. Saadat reviews imaging carefully to determine candidacy.
What is adjacent segment disease?
Adjacent segment disease refers to the accelerated breakdown of the discs immediately above and below a spinal fusion. Because the fused segment no longer moves, the neighboring discs absorb additional stress with every movement — over time, this can cause new compression on the spinal cord or nerve roots and may require additional surgery. Motion-preserving procedures are specifically designed to reduce this risk.
Does Dr. Saadat perform both cervical and lumbar motion-preserving procedures?
Yes. Dr. Saadat performs motion-preserving procedures for both the cervical (neck) and lumbar (lower back) spine at Cedars-Sinai Medical Center in Los Angeles and at his Orange County location. To find out whether you are a candidate, schedule a consultation online.