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Complex spine surgery · London

Cervical disc replacement, by a high-volume spine surgeon.

A motion-preserving alternative to ACDF for single or two-level cervical radiculopathy and mild myelopathy. Delivered in London complex spine units, with the right prosthesis for your neck and honest advice when fusion is the safer call.

A stethoscope on a clinical desk

Indicative pricing

What private cervical disc replacement costs in London.

Indicative all-in ranges across UK London complex spine units.

In short

Single-level cTDR under GA: £22,000–£35,000, home the next day.

Procedure Indicative range
Consultant spine consultation with MRI review £300–£450
Single-level cervical disc replacement (self-pay) £22,000–£35,000
Two-level cervical disc replacement (self-pay) £32,000–£45,000
Hybrid (arthroplasty + ACDF, two levels) £30,000–£45,000
Revision from prior anterior cervical surgery Case by case
Second-opinion review of MRI and clinic letters £250–£450

Prices vary by hospital, by surgeon, by prosthesis platform and by length of stay. NHS availability for cervical arthroplasty is patchy and highly consultant-dependent, so most patients seeking cTDR come through the private route.

The journey

From first message to return to sport, in order.

One team from your first appointment through consultation, surgery, discharge and rehab, including the six-week and six-month reviews.

  1. 04

    On the day

    Arrival at the hospital

    Admission on the morning of surgery, consent and marking. General anaesthesia, supine positioning with the neck gently extended on a support.

  2. 05

    On the day

    The operation itself

    60 to 90 minutes. Anterior Smith-Robinson approach through a 3 to 4 cm transverse crease, discectomy, PLL release, endplate preparation and prosthesis implantation under fluoroscopy.

  3. 06

    On the day

    Overnight or same-day discharge

    Selected single-level cases go home the same day. Two-level, myelopathic or older patients stay one night for observation and mobilisation.

  4. 07

    After

    Rehab, driving, sport

    Soft collar 1 to 2 weeks for comfort, driving at 2 to 3 weeks, desk work at 2 weeks, non-contact sport at 6 weeks, contact and impact sport at 12 weeks.

When it helps

When cTDR is the right operation, and when it is not.

The patient patterns where motion-preservation makes sense, alongside the anatomy and comorbidity that push us to ACDF or hybrid instead.

  • Single-level cervical radiculopathy

    Arm pain in a clear dermatomal pattern from a soft disc herniation or foraminal osteophyte at one level, C3 to C7, unresolved after conservative care.

  • Two-level cervical radiculopathy

    Adjacent-level disease with matching arm symptoms, where preserving motion at both segments is preferable to a two-level fusion.

  • Mild to moderate cervical myelopathy

    Cord compression from a soft disc with early hand clumsiness or gait change, where anterior decompression and motion preservation are appropriate.

  • Younger, active patient (30 to 65)

    Age 30 to 65, physically active, with healthy adjacent segments and good bone quality, where motion preservation matters over decades.

  • Failed non-operative care

    Six to twelve weeks of physiotherapy, gabapentinoids or a targeted cervical root injection, with persistent arm pain or progressive neurology.

  • Facet arthrosis: cTDR is not for you

    Significant posterior facet joint arthrosis on MRI or CT loads the prosthesis abnormally and drives heterotopic ossification. ACDF is the safer call.

  • Ankylosing spondylitis, DISH, instability

    A stiff or fused spine, or dynamic instability on flexion-extension films, contraindicates cTDR. Osteoporosis and prior fusion do too.

  • Red flag: progressive myelopathy

    Rapidly progressive weakness, bowel or bladder change, or severe cord compression needs urgent NHS assessment, not a private booking.

Prosthesis platforms

cTDR is a family of prostheses, and ACDF sits beside it.

The main platforms your surgeon will consider, and why sometimes an ACDF or a hybrid construct is the right answer instead.

  • Mobi-C (LDR / Zimmer Biomet)

    Mobile-core cobalt-chromium and polyethylene, FDA-approved for one and two levels, extensive IDE data. A workhorse in UK practice.

  • Prestige LP (Medtronic)

    Metal-on-metal (titanium-ceramic composite), ball-and-trough kinematics, keels for primary fixation. Strong ten-year data.

  • M6-C (Orthofix)

    Compressible polycarbonate urethane nucleus with a woven polyethylene annulus, mimicking natural disc biomechanics. Popular in Europe.

  • ProDisc-C (Centinel Spine)

    Ball-and-socket cobalt-chromium and polyethylene with a keeled fixation. Long clinical track record from IDE and post-market series.

  • Bryan (Medtronic)

    Titanium shells with a polyurethane nucleus in a saline-filled sheath. One of the earliest cervical arthroplasties, still in selected use.

  • Baguera-C (Spineart)

    Semi-constrained titanium and polyethylene design with a self-locking teeth fixation, no keel, marketed for straightforward revisability.

  • ACDF (fusion, when cTDR is not right)

    Anterior cervical discectomy and fusion with a cage and plate. The right call for facet arthrosis, instability or poor bone quality. Motion is lost at that level.

  • Hybrid construct

    Arthroplasty at one level and ACDF at an adjacent level in the same operation. Used when one level has healthy facets and the other does not.

Safety and recovery

Outcomes, risks and rehab, honestly.

Published series report 85 to 95% patient satisfaction, major improvement in the Neck Disability Index and over 90% arm-pain relief. The risks worth planning for are dysphagia, C5 palsy, heterotopic ossification and revision.

  • General anaesthesia and airway

    Full general anaesthesia with careful head and neck positioning. An anaesthetic assessment covers airway, cardiac and comorbidity risk before you consent.

  • Dysphagia (5 to 15%)

    Transient difficulty swallowing after the anterior approach is common but usually settles within days to weeks. Persistent dysphagia beyond three months is uncommon.

  • Recurrent laryngeal nerve palsy (1 to 3%)

    Hoarseness from stretch or pressure on the nerve. Usually transient and resolves within weeks to months; permanent palsy is uncommon.

  • C5 palsy (2 to 5%)

    Deltoid and biceps weakness in the first weeks after decompression at C4-C5 or C5-C6. Most cases recover fully over three to twelve months.

  • Heterotopic ossification (20 to 40%)

    Bone forms around the prosthesis on later X-rays in a substantial minority. Often asymptomatic and does not always restrict motion, but is discussed before you consent.

  • Subsidence and migration

    The prosthesis can settle into the endplate or shift a fraction of a millimetre. Modern fixation makes clinically significant subsidence uncommon.

  • Revision surgery (1 to 3% at 5 years)

    Revision for persistent symptoms, prosthesis failure, or progressive degeneration is uncommon but real. IDE trials suggest lower adjacent-segment reoperation than ACDF at ten years for some devices.

  • Soft collar and driving

    A soft collar for comfort for one to two weeks. Driving at two to three weeks once neck rotation is comfortable and you are off strong analgesia. Impact sport at twelve weeks.

  • Red flags after discharge

    Rapidly worsening arm or leg weakness, new bowel or bladder change, severe swelling in the neck, difficulty breathing or a fever above 38C. Call the unit or go to A&E the same day.

Reading your operation note

Your discharge letter in four parts. Read the last one first.

Whichever prosthesis is used, the letter your surgeon sends you keeps to the same shape.

  1. 01 Header

    Level, prosthesis and approach

    Which level was treated (C3-C4 to C6-C7), which prosthesis was implanted, and which side the anterior approach used.

  2. 02 Technique

    Decompression and implantation

    Whether the posterior longitudinal ligament was released, whether uncinate resection was needed, and the endplate preparation before implantation.

  3. 03 Findings

    Intra-operative notes and imaging

    Any dural exposure, CSF leak, blood loss and the intra-operative fluoroscopy showing prosthesis position, height and lordosis.

  4. 04 Impression

    Rehab plan and review

    Read this first: collar advice, driving and return-to-work timing, physiotherapy plan and the six-week and six-month review with flexion-extension films.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for cTDR varies by insurer and by indication. Usually funded when medically indicated with prior authorisation.

Frequently asked

Everything we get asked about cervical arthroplasty.

Quick answers on ACDF vs cTDR, cost, London centres, heterotopic ossification and return to work.

  • What is cervical disc replacement?

    Cervical disc replacement, also called cTDR or cervical arthroplasty, is an anterior neck operation that removes a worn or herniated cervical disc and replaces it with a motion-preserving prosthesis. Unlike ACDF, it aims to keep movement at that level rather than fuse it. It is done under general anaesthesia through a small transverse crease at the front of the neck, and most patients go home the day after surgery.

  • Cervical disc replacement or ACDF: which is better?

    For younger, active patients with a soft disc herniation, healthy facet joints and good bone quality, IDE trials of Mobi-C, Prestige LP, ProDisc-C and Bryan have shown non-inferiority and, at ten years, reduced adjacent-segment reoperation for some devices. For older patients, facet arthrosis, instability, ankylosing spondylitis or osteoporosis, ACDF is the safer and more durable option. NICE guidance IPG341 supports cervical arthroplasty in appropriately selected patients.

  • How much does private cervical disc replacement cost in the UK?

    Single-level self-pay is typically £22,000 to £35,000 all-in, two-level is £32,000 to £45,000, and hybrid constructs sit around £30,000 to £45,000. Prices include the surgeon, anaesthetist, prosthesis, hospital stay and standard post-operative follow-up.

  • Where in London can I have cervical disc replacement privately?

    The main London centres are HCA Wellington Hospital (Complex Spine Unit), London Bridge Hospital (Spine Unit), the Royal National Orthopaedic Hospital Private Care in Stanmore, and the Nuffield Health at Parkside. NHS availability is patchy and highly consultant-dependent, which is why most patients seeking cTDR come through the private route.

  • What is heterotopic ossification and does it matter?

    Heterotopic ossification is bone that forms around the prosthesis on later X-rays. It appears in roughly 20 to 40% of patients over five years, depending on the device and the classification used, but a majority of cases are low-grade and asymptomatic. High-grade ossification that bridges the segment and restricts motion is less common, and is discussed before you consent.

  • How quickly can I get back to work and sport?

    Desk work is usually possible at two weeks, driving at two to three weeks once you can turn your head comfortably and are off strong painkillers, non-contact sport at six weeks and contact or impact sport at twelve weeks. A soft collar is worn for one to two weeks for comfort. Your rehab plan is written into the discharge letter.

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