What is the superior surgical strategy for bi-level cervical spondylosis-anterior cervical disc replacement or anterior cervical decompression and fusion?

Abstract

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Comparison of cervical disc arthroplasty and anterior cervical discectomy and fusion for the treatment of cervical disc degenerative diseases on the basis of more than 60 months of follow-up: a systematic review and meta-analysis

“…It was worth noting that as a common complication after cervical surgery, the incidence of ASD was seem lower in the CDA group than in the ACDF group with our statistical results, which reveals that CDA may have a potential positive impact on reducing postoperative ASD at long-term follow-up. As mentioned above, due to the loss of segmental motion, patients after ACDF may have abnormal mobility at adjacent levels that can alter the biomechanical load and exacerbate degeneration of adjacent vertebrae [37]. Compared with fusion surgery, the mobility and flexibility of operative levels can be preserved in the CDA group, and a physiological functional spinal unit (FSU) can be conserved, which may benefit the natural degenerative process.…”

[Retracted] Study on the Adjustment of Cervical Spondylopathy in Middle‐Aged and Elderly People Based on CT Image Analysis

“…Cervical spondylosis, also known as cervical syndrome, is a degenerative pathological disease [ 1 ]. This disease is mainly caused by cervical disc deformation and cervical bone hyperplasia.…”

The Effectiveness of the Most Used Techniques in Patients With Degenerative Cervical Disease

“…This set of biomechanical changes leads to a return and/or worsening of the clinical picture (mainly cervical pain refractory to analgesic medications) associated with a decrease in functional recovery, requiring new surgical approaches not always satisfactory for the surgeon and their patient. [11][12][13][14] In order to avoid the harmful effects of the adjacent level syndrome, reduce the surgical reoperation rates, reduce intraoperative time and other disadvantages inherent to cervical decompression and cervical arthrodesis mentioned above, the technique of anterior cervical arthroplasty was created, which consists of replacing the degenerated cervical disc with an artificial cervical prosthesis preserving the movement inherent to the segment approached, reestablishing cervical alignment and maintaining intradiscal pressure, avoiding biomechanical changes capable of accelerating the degeneration of the levels adjacent to the surgical approach proposed to the patient. 12,13 (Figure 6)…”

“…Taking these eligibility criteria into account, the classic contraindications described for the use of cervical arthroplasty are loss of disc height greater than 50%, subluxation greater than two or three mm in dynamic cervical radiographic incidences, a previous cervical laminectomy, structural instability, recent history of cervical spine infection, ankylosing spondylitis, rheumatoid arthritis with cervical instability, ossification of the posterior longitudinal ligament, diffuse idiopathic skeletal hyperostosis and metabolic diseases that impair bone quality, myelopathy from compression of the vertebral body, presence of severe facet joint arthrosis, and morbid obesity that contraindicated the anterior approach to the cervical spine. 12,13 The main complications associated with this surgical technique may include persistent cervical pain, which can result from inadequate foraminal decompression in surgery; kyphotic deformity or severe facet joint disease; failure or breakage of the device; diagnostic error from not identifying the differential diagnoses that can mimic the clinical conditions of degenerative cervical disease; dysphagia; and heterotopic calcification (its rate increases considerably with the use of non-steroidal anti-inflammatories during the patient's postoperative recovery). These complications, especially persistent cervical pain, are usually more common in patients who have more serious clinical and radiological conditions in preoperative planning.…”