Current Concepts of Cervical Disc Arthroplasty.

BACKGROUND

Radiculopathy and myelopathy resulting from degenerative disc disease are currently treated with anterior cervical discectomy and fusion (ACDF), but there is a high incidence of adjacent segment disease after treatment.

METHODS

With recent advances in cervical disc arthroplasty (CDA), we performed a review of published articles, examining the latest clinical data on the efficacy, safety, and complications of the current cervical disc devices on the market. We focused on the long-term follow up data of single-level, multi-level, and hybrid CDA as compared to ACDF, paying close attention to the newest cervical disc devices. A search was performed utilizing PubMed, Google Scholar, and Clinical Key to identify articles on 1-level, 2-level, and hybrid approaches to CDA. The articles were reviewed by two authors for relevance and power with higher emphasis placed on FDA IDE trials.

RESULTS

The results conclude that CDA has an equivalent or improved clinical outcome when compared with ACDF with improved patient reported neck disability indexes and VAS neck pain scale. CDA also has lower rates of dysphagia, adjacent segment disease, and lower rates of reoperation when compared to ACDF. The data suggest there is no increased rate of reoperation in patients treated with multilevel CDA when compared to ACDF. In addition, the data from the limited clinical trials suggest that hybrid CDA and ACDF is safe and decreases risk of ASD.

CONCLUSION

CDA has been shown to be effective and safe with low complication rates. However, the data are of low quality, and more hybrid studies must be performed in the future to confirm these findings.

CLINICAL RELEVANCE: The reduction in overall postsurgical complications including ASD and in the need for additional surgery in the CDA group.

LEVEL OF EVIDENCE: 3.