Resolution of hypertension and secondary aldosteronism after surgical treatment of primary hyperparathyroidism.

BACKGROUND

Although cervical disc arthroplasty (CDA) is an established motion-preserving alternative to anterior cervical discectomy and fusion (ACDF), literature describing surgical technique and the learning curve remains limited. This study describes key surgical principles refined during a single surgeon's first 100 CDA levels and evaluates the associated learning curve.

METHODS

A retrospective review was performed of the first 100 CDA levels (52 patients) performed by a fellowship-trained spine surgeon between January 2024 and January 2026. Single-, double-, and triple-level CDA, as well as hybrid CDA-ACDF procedures, were included. Demographic, perioperative, radiographic, and clinical outcome data were collected. Operative duration, length of stay, and postoperative outcomes were analyzed. Risk-adjusted cumulative sum analysis was used to evaluate the surgical learning curve.

RESULTS

Operative duration increased significantly with procedural complexity (P < 0.001), while length of stay also differed according to operation type (P = 0.005). Risk-adjusted cumulative sum analysis demonstrated a learning curve with operative proficiency achieved after approximately 17 cases. Global cervical lordosis improved from 9.5° preoperatively to 15.5° postoperatively. Median modified Japanese Orthopedic Association improved from 16 to 18, Neck Disability Index decreased from 22 to 2, visual analog scale neck pain from 7 to 0, and visual analog scale upper limb pain from 4 to 0 (all P ≤ 0.002). Among patients with preoperative American Spinal Injury Association D status, 83.9% improved to American Spinal Injury Association E, with no neurological deterioration. Complications were uncommon.

CONCLUSIONS

CDA can be performed safely and reproducibly with adherence to key technical principles. Progressive improvements in operative efficiency demonstrate a measurable learning curve, while favorable early radiographic and clinical outcomes support the safety and reproducibility of this technique during early adoption.

CLINICAL RELEVANCE: Recognition of technical pearls and the expected learning curve may facilitate safer implementation of CDA and improve operative efficiency.

LEVEL OF EVIDENCE: Level 4, Retrospective case series.