Two-level cervical disc replacement involves replacing two adjacent degenerated cervical discs with artificial disc prostheses in a single operation. It preserves motion at both treated levels, potentially reducing the risk of adjacent segment disease compared to two-level fusion.
The approach is identical to single-level cervical disc replacement — through an anterior incision in the neck. Both affected discs are completely removed under microscope magnification. Two artificial discs are implanted into the prepared disc spaces. Each prosthesis consists of metal endplates articulating against a polyethylene core, allowing flexion, extension, lateral bending, and rotation. The operation takes one and a half to two and a half hours.
Two-level disc replacement is considered for younger patients (under 55–60) with cervical disc disease at two adjacent levels causing radiculopathy or myelopathy, who have preserved facet joints, no significant instability, and wish to maintain cervical motion.
Physiotherapy, pain management, cervical epidural injection. Two-level ACDF (fusion) is the main surgical alternative.
MRI and CT for planning. Assessment of facet joint status at both levels. Vascular imaging may be needed.
Motion preservation at two levels, potentially reducing the risk of adjacent segment disease. Studies show non-inferiority to two-level ACDF at seven to ten year follow-up, with maintenance of segmental motion.
Swallowing difficulty. More common with two-level than single-level anterior surgery. Usually temporary.
Recurrent laryngeal nerve irritation. Usually temporary.
Temporary.
Bone formation limiting motion at one or both levels. Reported in 10–40% but clinically significant restriction in fewer.
One or both prostheses may shift.
Risk approximately 0.5–1%.
Rare.
Very rare.
May still occur despite motion preservation.
General anaesthesia. Supine with neck extended. Neuromonitoring may be used.
Hospital one to two days. No collar needed (unlike fusion). Gentle neck exercises from one week. Return to desk work at two to four weeks. Driving at two to four weeks. Full activity at six to eight weeks. No smoking restrictions as fusion is not the goal.
X-rays at six weeks (including flexion-extension views) and six months. Annual review for five years.
Fusing two levels significantly restricts neck motion and doubles the stress on adjacent segments. Preserving motion at both levels maintains more natural neck mechanics and may reduce long-term adjacent segment disease.
NSAIDs taken for two to four weeks after surgery may reduce heterotopic bone formation. Even when HO occurs, clinically significant motion loss is less common than the radiographic appearance suggests.