One of the most common issues that arise in our practice is well discussed by Dr. Neubardt in the educational video and relates to the choice we the surgeons and US patients have between an anterior cervical discectomy with fusion versus an artificial disc also called an arthroplasty. It has been noted that with cervical spine fusion and the passage of time, adjacent disc level seemed to deteriorate faster. On the simplistic level, this may represent the fact that with two vertebrae fused the adjacent levels have to do more of the “work.” The rationale therefore with an arthroplastic mobile device is that it would decrease the incidence of adjacent segment disease. Therefore, one of the most elementary issues to ask is, what is the incidence and rate of the development of adjacent segment disease? Most studies would indicate that with the single-level fusion, the rate of an adjacent level developing degeneration is 1% per year. Those studies would also indicate that it is more likely to see adjacent segment disease in those patients in whom that the adjacent level already demonstrates some evidence of degeneration.