Cervical Disc Arthroplasty

Anterior cervical discectomy and fusion (ACDF) is a common surgical procedure for treatment of cervical radiculopathy and myelopathy due to cervical disc disease. Although it is a generally successful and safe procedure (complication rate between 2 and 4%), more recent studies have raised concerns regarding alterations of cervical spine biomechanics following a fusion. The fusion of a cervical segment leads to increased stress and loading on the adjacent segments which in turn can accelerate the degeneration process. Current estimates suggest that 25% of patients treated with ACDF will develop adjacent segment degeneration at 10 years (3% per year) and half of these patients will require new surgical intervention. Cervical disc arthroplasty (CDA) was developed as an alternative procedure to preserve motion both at the affected and adjacent levels and theoretically lower rates of adjacent segment degeneration. Prospective randomized trials comparing ACDF with CDA were initiated in 2000 and have demonstrated significant differences in some clinical outcome measures favouring CDA and comparable safety profiles between the two techniques. Following these trials many different devices have been licensed and are currently available on the market. The typical candidate patient for CDA is the young active adult patient with single level symptomatic disc disease and with intact posterior facet joints. The aim of this chapter is to critically review available literature supporting clinical use of CDA. Cervical disc replacement is nowadays an accepted technique with established short and medium-term follow-up data, however only long-term data will be able to confirm the promise of decreased adjacent segment disease and lower reoperation rate.