Cervical Disc Replacement

Introduction

In response to clinical concerns and complications related to fusion, ADR has been proposed as a viable alternative method of managing cervical spondylosis.  interest in and enthusiasm for this technology has increased in recent years. Pros and cons benefit potential to preserve motion pseudoarthrosis not a concern quicker return to routine activities risks hardware failure with potential paralysis persistent neck pain from pain originating from facets Evidence A number of randomized controlled trials comparing CDA with ACDF have shown better functional recovery and reduced the risk of re-operations with CDA. Long-term studies are needed.  History 1966: Fernström first implanted a stainless steel ball bearing in the cervical spine but reported unacceptable rates of device-related complications. at that time, ACDF was gaining popularity with reports of great clinical success and therefore interest in motion preserving procedures decreased. 1980-90s: a renewed interest in cervical ADR resurfaced when lumbar disk arthroplasty gained in popularity use in Europe.  2002: first report on modern cervical ADR appeared with the premise that it would decrease or prevent adjacent segment disease by maintaining motion 2010 to present several RCT showing superiority to cervical fusion with regard to reoperation rate quicker return to work

Indications

Indications single and double level cervical radiculopathy single and double level cervical myelopathy Contraindications significant facet degeneration

Preoperative Imaging

Radiographs AP and lateral of cervical spine CT scan useful to determine positioning and sizing of THA MRI required to evaluate central and foraminal stenosis.

Technique

Approach anterior approach to cervical spine  Biomechanics critical to align center of rotation in both coronal and saggital plane especially important in two level CDA

Complications

Hardware failure  may have catastrophic consequece in retropulsion into spinal canal