Cervical disc arthroplasty: What we know in 2020 and a literature review

Abstract

Cervical disc arthroplasty (CDA) is a safe and effective option to improve clinical outcomes (e.g., NDI, VAS, and JOA) in degenerative cervical disc disease and compressive myelopathy. CDA’s two main purported benefits have been that it maintains physiologic motion and thereby minimizes the biomechanical stresses placed on adjacent segments as compared to an ACDF. CDA might reduce the degeneration of adjacent segments, and the need for adjacent-level surgery. Reoperation rates of CDA have been reported to range from 1.8% to 5.4%, with a minimum 5-year follow-up. As the number of CDA procedures performed continues to increase, the need for revision surgery is also likely to increase. When performed skillfully in appropriate patients, CDA is an effective surgical technique to optimize clinical outcomes and radiological results. This review may assist surgical decision-making and enable a more effective and safer implementation of cervical arthroplasty for cervical degenerative disease.

Safety and Validity of Anterior Cervical Disc Replacement for Single-level Cervical Disc Disease: Initial Two-year Follow-up of the Prospective Observational Post-marketing Surveillance Study for Japanese Patients

“…At least nine types of CAD are currently in use for 1-or 2level ACDR, including Mobi-C and Prestige LP. [4][5][6][7][8][9] Clinical trials have reported the safety and efficacy of ACDR, including prospective, multicenter, and randomized trials comparing ACDR and ACDF, such as the Investment Device Exemption (IDE) clinical trials in the USA (Table 5). Positive results have demonstrated the superiority of ACDR over ACDF in terms of improvement in neurological condition, patient satisfaction, maintenance of cervical spine ROM, and surgery-related complications.…”

“…To date, at least nine types of CAD are available for clinical use. [4][5][6][7][8][9] The advantage of ACDR is that it maintains the range of motion (ROM) at the surgical level, thus reducing the postoperative risk of adjacent disc disease compared with conventional anterior cervical discectomy and fusion (ACDF). Although a number of studies have suggested beneficial effects of ACDR compared with ACDF in the medium to long term, many others have questioned the superiority of ACDR.…”

A Bibliometric Analysis of the Top 100 Cited Articles in Anterior Cervical Discectomy and Fusion

“… 124 Nine artificial discs have received US FDA approval: Prestige ST, Prestige LP, Prodisc-C, Bryan, Secure-C, PCM, Mobi-C, M6-C, and Simplify. 125 Compared with ACDF, CDA was superior or equivalent in terms of length of stay (LOS), clinical indicators, range of motion (ROM) of the cervical spine, adverse events, and reoperation rates. 29 , 97 , 109 , 126 Although CDA has some advantages over ACDF in surgical outcomes, the indications of CDA are relatively narrow, the procedure is more complex, 117 , 119 and the financial requirements of patients are higher, 127 all of which limit the application of CDA in the clinic.…”

“…Some scholars believe that postoperative complications of CDA, such as heterotopic ossification (HO), osteolysis, and aseptic loosening caused by abrasion, spontaneous fusion, and postoperative hematoma, are also one of the factors limiting its wide application. 125,128 Since ACDFs are performed each year compared to only 1600 CDAs, with a ratio of 81:1. 51 Junbo He et al analyzed the top 100 cited publications on anterior cervical surgery and found that 80% of the publications were related to ACDF.…”

Effect of facet joint distraction on the functional and radiological outcomes after anterior cervical disc replacement

“…ACDR has a similar effect to ACDF in the treatment of cervical spondylotic radiculopathy and may even be superior in some clinical outcomes [ 8 , 9 ], particularly in terms of cervical mobility and avoidance of adjacent segment disease [ 10 ]. Both of them use a similar surgical technique that uses the anterior cervical approach to remove the degenerated intervertebral disc and implant the prosthetic to maintain the intervertebral height and achieve decompression of nerve [ 11 ]. However, both surgeries can potentially expand the intervertebral space and alter the facet joint distance.…”