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Updated: Jun 7 2021

Cervical Disc Arthroplasty

Images
https://upload.orthobullets.com/topic/12279/images/046be4d4-6c1f-4aba-aa28-764fbea27e7d_single_level_lateral..jpg
https://upload.orthobullets.com/topic/12279/images/6ab8db6e-5d1f-4f21-b5af-ad774998a74c_single_level_coronal..jpg
https://upload.orthobullets.com/topic/12279/images/abcd9f8c-0571-4cb1-89ae-06dd30599271_2_level..jpg
  • SUMMARY
    • Cervical Disc Arthroplasty is a motion preserving technique that has shown to be equivalent, and superior in two level disease, to cervical fusion.
    • There is mounting evidence that by avoiding a fusion, adjacent level disease and subsequent reoperation rates, are decreased.
    • Primary contraindication is advanced degenerative disease of the facets with associated neck pain. 
  • History
    • 1966: Fernstr√∂m 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
  • OUTCOMES
    • 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
      • single-level disease
        • CDA equivalent to fusion in
          • neurologic improvement
          • patient reported outcomes
        • CDA superior to fusion in
          • reoperation rate
      • two-level disease
        • CDA equivalent to fusion in
          • neurologic improvement
          • patient reported outcomes
        • CDA superior to
  • Indications
    • Indications
      • primary CDA
        • single and double level cervical radiculopathy
        • single and double level cervical myelopathy
      • revision CDA
        • if performed within 2 weeks results are equivalent to revisoin
    • 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
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