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Review
. 2018 Feb;8(1):78-83.
doi: 10.1177/2192568217701095. Epub 2017 May 16.

Cervical Disc Arthroplasty: A Comprehensive Review of Single-Level, Multilevel, and Hybrid Procedures

Joseph L Laratta  1 , Jamal N Shillingford  1 , Comron Saifi  1 , K Daniel Riew  1
Affiliations
Review

Cervical Disc Arthroplasty: A Comprehensive Review of Single-Level, Multilevel, and Hybrid Procedures

Joseph L Laratta et al. Global Spine J. 2018 Feb.

Abstract

Study design: Systematic review.

Objectives: Degenerative disc disease and spondylosis resulting in radiculopathy and retrodiscal myelopathy are among the most frequently encountered cervical spinal disorders. Traditionally, anterior cervical discectomy and fusion (ACDF) has successfully achieved neural decompression and restored intradiscal height in these conditions. Unfortunately, nonunion and iatrogenic adjacent segment pathology associated with fusion procedures in the cervical spine has led to an interest in motion-preserving procedures. Cervical disc arthroplasty (CDA) was developed in hopes of preserving cervical biomechanics while mitigating the complications associated with ACDF. Through a systematic review of both published and ongoing studies on single- and multilevel CDA, and hybrid surgeries, we aim to provide evidence for their safety and efficacy in the treatment of various cervical pathologies.

Methods: A systematic search of several large databases, including Cochrane Central, PubMed, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry was conducted to identify published studies and ongoing clinical trials on CDA and hybrid surgery.

Results: Among the relevant studies reviewed, 3 were randomized controlled trials, 2 systematic reviews, as well as multiple prospective case series, biomechanical studies, and meta-analyses.

Conclusion: Over the past decade, multiple high-quality studies have shown that single-level CDA can offer equivalent clinical outcomes with a reduction in secondary procedures and total cost when compared to ACDF. However, more recently there has been an increasing prevalence of 2-level CDA and hybrid surgery. Although the data regarding these multilevel procedures is less robust, it appears that they may be as effective as their single-level counterparts.

Keywords: ACDF; cervical disc arthroplasy; hybrid surgery; multilevel.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Riew reports personal fees from AOSpine, various universities for visiting professorships, personal fees from Biomet, Medtronic, other support from Expanding Orthopaedics, personal fees from Expert Testimony, grants from Medtronic, other support from Amedica, Benvenue, Nexgen Spine, Paradigm Spine, Spinal Kinetics, Spineology, Vertiflex, and outside the submitted work.

Figures

Figure 1.
Figure 1.
Two-level cervical disc arthroplasty.
Figure 2.
Figure 2.
Hybrid construct with anterior cervical discectomy and fusion (ACDF) superjacent to cervical disc arthroplasty (CDA).
Figure 3.
Figure 3.
Hybrid construct with anterior cervical discectomy and fusion (ACDF) subjacent to cervical disc arthroplasty (CDA).
See this image and copyright information in PMC

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