Cervical disc arthroplasty

Cervical disc arthroplasty is a procedure involving the replacement of degenerative cervical intervertebral discs with artificial discs to enable decompression of the cervical spinal cord.  

This procedure is an alternative to anterior cervical discectomy and fusion (ACDF) and avoids the loss of joint motion and adjacent segment degeneration associated with ACDF ¹. 

Indications

• symptomatic cervical radiculopathy/myelopathy secondary to disc pathology at 1 or 2 levels between C3-C7, that is refractory to conservative management ²

Contraindications

• involvement of >2 levels
• pathological processes affecting bone quality (e.g. osteoporosis, trauma, etc.) ^2,3

Procedure

Positioning

Patients should be placed in a supine position with their neck at a neutral position to assist accurate implant measurement ¹. 

Technique

This procedure involves an anterior neck incision to gain access to the cervical vertebrae. Following the incision, the surgical approach involves passing medial to the sternocleidomastoid muscle and carotid sheath. The pathological intervertebral disc is subsequently resected as well as any osteophytes. Cervical disc implants of increasing size are trialed to assess the most appropriate implant for the patient. Once selected, manufacturer instructions are followed for correct implantation ^1,2.

Complications

Cervical disc arthroplasty is generally considered safe, however, complications can arise such as: 

• intraoperative complications:
  • damage to anatomical structures intra-operatively  
• immediate postoperative complications: 
  • dysphagia 
  • new-onset neurological impairments 
  • recurrent laryngeal nerve injury
• delayed complications:
  • heterotopic ossification ^2,4

Outcomes

One meta-analysis found that in comparison to ACDF, cervical disc arthroplasty achieved greater success long-term measured by the neck disability index ⁵.