Dr. Zeeshan Sardar, MD, MSc, F.R.C.S.C
Director, Quality & Patient Safety (QPS) – Och Spine Hospital
Medical Director, Spine Unit – Och Spine Hospital
Co-Chief of Spinal Deformity Surgery • NewYork-Presbyterian / Columbia University
Och Spine Hospital • New York, NY
Spinal fusion has been the cornerstone of surgical treatment for degenerative spine disease for decades — and for many conditions, it remains the most appropriate procedure. But fusion has a cost: it eliminates motion at the treated level and transfers increased mechanical stress to adjacent levels, accelerating degeneration over time. For some patients, this trade-off is unavoidable. For others, it is not. Motion-preserving spine surgery refers to a family of surgical approaches that decompress neural structures while maintaining or restoring normal movement at the treated spinal levels. Dr. Sardar is one of the most experienced motion-preserving spine surgeons in New York, having completed a dedicated fellowship in artificial disc replacement at the Texas Back Institute and offering the full range of motion-preserving options for both the cervical and lumbar spine.
CERVICAL DISC REPLACEMENT (ARTHROPLASTY)
Cervical disc replacement is the most evidence-supported motion-preserving procedure in spine surgery. The diseased disc is removed and replaced with an artificial disc implant that preserves motion at the treated level, achieving the same decompression as ACDF while maintaining the biomechanics of the cervical spine. Over a decade of prospective randomized clinical trial data demonstrates equivalent neurological outcomes to ACDF with significantly lower rates of reoperation at adjacent levels at 7–10 year follow-up. It is FDA-approved for 1–2 level disease in appropriately selected patients. Best for younger, active patients with 1–2 level cervical disc disease, preserved cervical lordosis, and no significant facet arthritis or instability.
LUMBAR DISC REPLACEMENT
Lumbar artificial disc replacement replaces a degenerated lumbar disc with a motion-preserving implant, addressing discogenic pain and radiculopathy without eliminating motion at the treated level. FDA-approved for single-level use at L4–5 and L5–S1 in carefully selected patients. Best for patients under 60 with single-level lumbar disc degeneration causing significant axial back pain or radiculopathy, without significant facet arthritis, instability, or deformity.
CERVICAL LAMINOPLASTY
For patients with multilevel cervical stenosis causing myelopathy, laminoplasty is a posterior motion-preserving alternative to multilevel cervical fusion. Rather than removing the laminae or fusing the cervical spine, laminoplasty hinges the laminae open to enlarge the spinal canal and decompress the cord while preserving the posterior bony architecture and maintaining motion. Appropriate for patients with multilevel compression (3+ levels), preserved cervical lordosis, and predominantly posterior compression.
POSTERIOR CERVICAL FORAMINOTOMY
For selected patients with cervical radiculopathy from a soft disc herniation or foraminal stenosis at a single level, posterior cervical foraminotomy — a minimally invasive posterior approach that widens the foramen and removes the disc or osteophyte causing nerve compression — achieves decompression without fusion or disc replacement. Full range of motion is preserved.
FREQUENTLY ASKED QUESTIONS
Is motion-preserving surgery always better than fusion?
Not always. Fusion can be the more appropriate and effective option for many conditions, including instability, deformity, and multilevel disease. Motion preservation is a tool for a specific subset of well-selected patients.
How do I know if I’m a candidate?
Candidacy depends on the number of levels involved, alignment, facet joint health, and the nature of the compression, assessed through detailed imaging review.
Does preserving motion really reduce problems at adjacent levels?
Long-term trial data shows lower reoperation rates at adjacent levels with cervical disc replacement compared to fusion, though it doesn’t eliminate the normal aging process at other levels.
Will my surgeon automatically offer me this option if I qualify?
Motion-preserving candidacy should be evaluated as a standard part of surgical planning, not as an afterthought, for any patient with cervical or lumbar disc disease being considered for surgery.
Are these procedures newer or less proven than fusion?
Cervical disc replacement has over a decade of prospective randomized trial data. It’s well-established for appropriately selected patients, not experimental.
HOW DR. SARDAR SELECTS THE RIGHT PROCEDURE
Not every patient is a candidate for motion-preserving surgery, and Dr. Sardar does not default to any single approach. For every patient who comes in for a cervical or lumbar surgical consultation, he explicitly evaluates candidacy for motion-preserving options and discusses them as part of the surgical planning conversation — not as an afterthought, but as a primary consideration. The selection process is individual and based on careful review of MRI, CT, and standing X-rays; number of levels involved; cervical alignment; facet joint health; nature of the compression; and the patient’s age, activity level, and goals.
This page is for educational purposes only and does not constitute individualized medical advice.
To schedule a consultation, call 212-932-5187 or visit the contact page.