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

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.

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Ten-Year Outcomes of 1- and 2-Level Cervical Disc Arthroplasty From the Mobi-C Investigational Device Exemption Clinical Trial

Neurosurgery ◽

10.1093/neuros/nyaa459 ◽

2020 ◽

Author(s):

Kee Kim ◽

Greg Hoffman ◽

Hyun Bae ◽

Andy Redmond ◽

Michael Hisey ◽

...

Keyword(s):

Neck Disability Index ◽

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Adjacent Segment ◽

Disc Disease ◽

Cervical Arthroplasty ◽

Disc Arthroplasty ◽

Arm Pain ◽

Pain Outcomes ◽

Neck Disability

Abstract BACKGROUND Short- and mid-term studies have shown the effectiveness of cervical disc arthroplasty (CDA) to treat cervical disc degeneration. OBJECTIVE To report the 10-yr outcomes of a multicenter experience with cervical arthroplasty for 1- and 2-level pathology. METHODS This was a prospective study of patients treated with CDA at 1 or 2 contiguous levels using the Mobi-C® Cervical Disc (Zimmer Biomet). Following completion of the 7-yr Food and Drug Administration postapproval study, follow-up continued to 10 yr for consenting patients at 9 high-enrolling centers. Clinical and radiographic endpoints were collected out to 10 yr. RESULTS At 10 yr, patients continued to have significant improvement over baseline Neck Disability Index (NDI), neck and arm pain, neurologic function, and segmental range of motion (ROM). NDI and pain outcomes at 10 yr were significantly improved from 7 yr. Segmental and global ROM and sagittal alignment also were maintained from 7 to 10 yr. Clinically relevant adjacent segment pathology was not significantly different between 7 and 10 yr. The incidence of motion restricting heterotopic ossification at 10 yr was not significantly different from 7 yr for 1-level (30.7% vs 29.6%) or 2-level (41.7% vs 39.2%) patients. Only 2 subsequent surgeries were reported after 7 yr. CONCLUSION Our results through 10 yr were comparable to 7-yr outcomes, demonstrating that CDA with Mobi-C continues to be a safe and effective surgical treatment for patients with 1- or 2-level cervical degenerative disc disease.

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History of cervical disc arthroplasty

Neurosurgical FOCUS ◽

10.3171/2009.6.focus09128 ◽

2009 ◽

Vol 27 (3) ◽

pp. E10 ◽

Cited By ~ 19

Author(s):

Ali A. Baaj ◽

Juan S. Uribe ◽

Fernando L. Vale ◽

Mark C. Preul ◽

Neil R. Crawford

Keyword(s):

Cervical Spine ◽

Load Transfer ◽

The Other ◽

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Adjacent Segment ◽

Cervical Arthroplasty ◽

Disc Arthroplasty ◽

History Of ◽

Adjacent Segments

Enthusiasm for cervical disc arthroplasty is based on the premise that motion-preserving devices attenuate the progression of adjacent-segment disease (ASD) in the cervical spine. Arthrodesis, on the other hand, results in abnormal load transfer on adjacent segments, leading to the acceleration of ASD. It has taken several decades of pioneering work to produce clinically relevant devices that mimic the kinematics of the intervertebral disc. The goal of this work is to trace the origins of cervical arthroplasty technology and highlight the attributes of devices currently available in the market.

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A Comparison of Cervical Disc Arthroplasty and Anterior Cervical Discectomy and Fusion in Patients with Two-Level Cervical Degenerative Disc Disease: 5-Year Follow-Up Results

World Neurosurgery ◽

10.1016/j.wneu.2018.10.231 ◽

2019 ◽

Vol 122 ◽

pp. e1083-e1089 ◽

Cited By ~ 5

Author(s):

Xinlin Gao ◽

Yi Yang ◽

Hao Liu ◽

Yang Meng ◽

Junfeng Zeng ◽

...

Keyword(s):

Degenerative Disc Disease ◽

Anterior Cervical Discectomy ◽

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Disc Disease ◽

Disc Arthroplasty ◽

Cervical Discectomy ◽

Degenerative Disc ◽

Cervical Degenerative Disc Disease

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Mid- to Long-Term Outcomes of Cervical Disc Arthroplasty versus Anterior Cervical Discectomy and Fusion for Treatment of Symptomatic Cervical Disc Disease: A Systematic Review and Meta-Analysis of Eight Prospective Randomized Controlled Trials

PLoS ONE ◽

10.1371/journal.pone.0149312 ◽

2016 ◽

Vol 11 (2) ◽

pp. e0149312 ◽

Cited By ~ 39

Author(s):

Yan Hu ◽

Guohua Lv ◽

Siying Ren ◽

Daniel Johansen

Keyword(s):

Meta Analysis ◽

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Controlled Trials ◽

Long Term Outcomes ◽

Cervical Disc Disease ◽

Disc Disease ◽

Disc Arthroplasty ◽

Randomized Controlled

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Secondary Surgery after Cervical Disc Arthroplasty versus Fusion for Cervical Degenerative Disc Disease: A Meta-analysis with Trial Sequential Analysis

Orthopaedic Surgery ◽

10.1111/os.12401 ◽

2018 ◽

Vol 10 (3) ◽

pp. 181-191 ◽

Cited By ~ 3

Author(s):

Ru-sen Zhu ◽

Shun-li Kan ◽

Ze-gang Cao ◽

Ze-hua Jiang ◽

Xue-li Zhang ◽

...

Keyword(s):

Degenerative Disc Disease ◽

Sequential Analysis ◽

Meta Analysis ◽

Cervical Disc ◽

Trial Sequential Analysis ◽

Cervical Disc Arthroplasty ◽

Disc Disease ◽

Secondary Surgery ◽

Disc Arthroplasty ◽

Degenerative Disc

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Myelopathy after cervical disc arthroplasty due to progression of spondylosis at the index level: case report

Journal of Neurosurgery Spine ◽

10.3171/2017.8.spine161385 ◽

2018 ◽

Vol 28 (5) ◽

pp. 467-471

Author(s):

Anita Bhansali ◽

Michael Musacchio ◽

Noam Stadlan

Keyword(s):

Case Report ◽

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Artificial Disc ◽

Rare Occurrence ◽

Disc Disease ◽

Disc Arthroplasty ◽

Low Incidence ◽

Index Level ◽

Better Than

Cervical disc arthroplasty (CDA) has emerged as a popular alternative to anterior cervical discectomy and fusion (ACDF) for the surgical treatment of cervical degenerative disc disease. CDA has been well studied, with efficacy reported to be equivalent to or better than that seen with ACDF, and it is associated with a consistently low incidence of adverse events. The development or progression of myelopathy after CDA is a particularly rare occurrence. In this report, the authors describe the first known case of recurrence of myelopathy at the index level of surgery after CDA implantation due the continuation of the spondylitic process after placement of the artificial disc.

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Differences between C3–4 and other subaxial levels of cervical disc arthroplasty: more heterotopic ossification at the 5-year follow-up

Journal of Neurosurgery Spine ◽

10.3171/2015.10.spine141217 ◽

2016 ◽

Vol 24 (5) ◽

pp. 752-759 ◽

Cited By ~ 14

Author(s):

Peng-Yuan Chang ◽

Hsuan-Kan Chang ◽

Jau-Ching Wu ◽

Wen-Cheng Huang ◽

Li-Yu Fay ◽

...

Keyword(s):

Cervical Spine ◽

Heterotopic Ossification ◽

Clinical Outcomes ◽

Large Scale ◽

Japanese Orthopaedic Association ◽

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Disc Arthroplasty ◽

Arm Pain

OBJECTIVE Several large-scale clinical trials demonstrate the efficacy of 1- and 2-level cervical disc arthroplasty (CDA) for degenerative disc disease (DDD) in the subaxial cervical spine, while other studies reveal that during physiological neck flexion, the C4–5 and C5–6 discs account for more motion than the C3–4 level, causing more DDD. This study aimed to compare the results of CDA at different levels. METHODS After a review of the medical records, 94 consecutive patients who underwent single-level CDA were divided into the C3–4 and non-C3–4 CDA groups (i.e., those including C4–5, C5–6, and C6–7). Clinical outcomes were measured using the visual analog scale for neck and arm pain and by the Japanese Orthopaedic Association scores. Postoperative range of motion (ROM) and heterotopic ossification (HO) were determined by radiography and CT, respectively. RESULTS Eighty-eight patients (93.6%; mean age 45.62 ± 10.91 years), including 41 (46.6%) female patients, underwent a mean follow-up of 4.90 ± 1.13 years. There were 11 patients in the C3–4 CDA group and 77 in the non-C3–4 CDA group. Both groups had significantly improved clinical outcomes at each time point after the surgery. The mean preoperative (7.75° vs 7.03°; p = 0.58) and postoperative (8.18° vs 8.45°; p = 0.59) ROMs were similar in both groups. The C3–4 CDA group had significantly greater prevalence (90.9% vs 58.44%; p = 0.02) and higher severity grades (2.27 ± 0.3 vs 0.97 ± 0.99; p = 0.0001) of HO. CONCLUSIONS Although CDA at C3–4 was infrequent, the improved clinical outcomes of CDA were similar at C3–4 to that in the other subaxial levels of the cervical spine at the approximately 5-year follow-ups. In this Asian population, who had a propensity to have ossification of the posterior longitudinal ligament, there was more HO formation in patients who received CDA at the C3–4 level than in other subaxial levels of the cervical spine. While the type of artificial discs could have confounded the issue, future studies with more patients are required to corroborate the phenomenon.

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