Cervical disc replacement surgery: indications, technique, and technical pearls

Abstract

Purpose of review: Cervical disc replacement (CDR) is a surgical option for appropriately indicated patients, and high success rates have been reported in the literature. Complications and failures are often associated with patient indications or technical variables, and the goal of this review is to assist surgeons in understanding these factors.

Recent findings: Several investigations have been published in the last 5 years supporting the use of CDR in specific patient populations. CDR has been shown to be comparable or favorable to anterior cervical discectomy and fusion in several meta-analyses and mid-term follow-up studies. CDR was developed as a technique to preserve motion following a decompression procedure while minimizing several of the complications associated with fusion and posterior cervical spine procedures. Though success with cervical fusion and posterior foraminotomy has been well documented in the literature, high rates of mid- and long-term complications have been clearly established. CDR has also been associated with several complications and challenges with regard to surgical technique, though improvements in implant design have lead to an increase in utilization. Several devices currently exist and vary in terms of material, design, and outcomes. This review paper discusses indications, surgical technique, and technical pearls and reviews the CDR devices currently available.

Keywords: Anterior cervical discectomy and fusion (ACDF); Cervical degenerative disc disease; Cervical disc arthroplasty; Disc replacement; Myelopathy; Radiculopathy.

Conflict of interest statement

Conflict of interest

Kris Radcliff reports personal fees from Globus Medical, personal fees from Depuy, personal fees from Stryker, personal fees from MEdtronic, personal fees from Orthopedic Sciences, Inc., personal fees from Nuvasive, personal fees from 4 Web MEdical, other from LDR Medical (now Zimmer), outside the submitted work, and shareholder status Rothman Institute.

All the other authors declare no conflict of interest.

Human and animal rights and informed consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Figures

Fig. 1

a-d. a and b Intraoperative floursocopy following C5–7 CDA in a 41-year-old male with two level degenerative disc disease. c and d 1 year postoperative visit showing implant subsidence

Fig. 2

Parallel end plates obtained on fluoroscopy

Fig. 3

Bryan artificial disc and lateral radiograph

Fig. 4

Mobi-C Lateral and AP Radiographs