Updated: 4/6/2017

Cervical Disc Replacement

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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 dresurfaced 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
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
 

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