What Is Motion-Preserving Spine Surgery?

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, motion-preserving surgery may be an option. It treats the source of neck or back pain and keeps the treated segment flexible instead of permanently joining the vertebrae. Whether you qualify depends on your diagnosis and imaging.

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. If you’re dealing with this, learn more about our spine surgery treatment philosophy approach.
Below is an overview of the most common procedures, who qualifies, and how they compare to traditional fusion.

Below, we cover the two most common cervical motion-preserving options, who qualifies, and how they compare with fusion.

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 

Cervical disc replacement removes a degenerated disc that is compressing the spinal cord or a nerve root and replaces it with an artificial disc, so the segment keeps moving. The traditional alternative is anterior cervical discectomy and fusion (ACDF), which removes the same disc and fuses the vertebrae.

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

Disc replacement preserves motion. It does not create motion. A severely arthritic segment that did not move before surgery is unlikely to move after disc replacement. For patients with severe facet arthritis and neck pain in addition to arm pain, ACDF may be a more suitable 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.

Posterior cervical laminoplasty is a motion-sparing way to decompress the spinal cord in patients with severe compression at multiple levels, normal neck alignment, and minimal neck pain. The lamina forms a rigid roof over the spinal canal. In a laminoplasty, the surgeon creates a hinge on one side of the lamina and wedges the other side open with a small metallic plate. This makes more room for the spinal cord without a fusion.

Most patients notice immediate relief of arm pain and some improvement in hand numbness, and usually stay one or two nights in the hospital.

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 is a candidate for motion-preserving spine surgery. The best candidates have a single-level disc problem, little or no spinal instability, no significant facet joint arthritis, good bone quality, and no prior fusion at the level being treated. The goal is to relieve pain and pressure on the spinal cord or nerves without removing movement at that segment.

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.

Motion-preserving spine surgery is best suited for patients with a localized disc problem who want to keep natural movement. A full evaluation, including imaging and a physical exam, determines whether you are a 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.

Who Is Not a Good Candidate for Disc Replacement?

Disc replacement may not be suitable when the spine is unstable, there is significant arthritis in the facet joints, bone quality is poor, or there is an infection, among other factors. The surgeon determines candidacy based on imaging and examination.

Does Disc Replacement Prevent Problems in Neighboring Discs?

The goal of preserving motion is to reduce the additional stress that fusion may place on neighboring levels. Some studies suggest lower rates of adjacent-level problems than with fusion, but disc replacement does not guarantee that these problems will not occur. Ask your surgeon how the evidence applies to your situation.

What Is Motion-Preserving Spine Surgery?

Motion-preserving surgery aims to treat a spinal problem while keeping movement at the treated level, for example, by replacing a disc with an artificial one instead of fusing the bones together. It is not appropriate for every condition.