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. 2024 Nov 8;18(5):514-520.
doi: 10.14444/8603.

Four-Level Cervical Disc Arthroplasty

Hsuan-Kan Chang  1   2   3 , Chih-Chang Chang  1   2 , Tsung-Hsi Tu  1   2 , Yi-Hsuan Kuo  1   2 , Ching-Lan Wu  4   5 , Mei-Yin Yeh  1   2   6 , Chao-Hung Kuo  1   2 , Chin-Chu Ko  1   2   6 , Li-Yu Fay  1   2   6 , Wen-Cheng Huang  1   2 , Jau-Ching Wu  1   2   6
Affiliations

Four-Level Cervical Disc Arthroplasty

Hsuan-Kan Chang et al. Int J Spine Surg. .

Abstract

Background: Multilevel anterior cervical discectomy and fusion inevitably yields a higher chance of pseudarthrosis or require more reoperations than single-level procedures. Therefore, multilevel cervical disc arthroplasty (CDA) could be an alternative surgery for cervical spondylosis, as it (particularly 3- and 4-level CDA) could preserve more functional motility than single-level disc diseases. This study aimed to investigate the clinical and radiological outcomes of 4-level CDA, a relatively infrequently indicated surgery.

Methods: The medical records of consecutive patients who underwent 4-level CDA were retrospectively reviewed. These highly selected patients typically had multilevel disc herniations with mild spondylosis. The inclusion criteria were symptomatic cervical spondylotic myelopathy, radiculopathy, or both, that were medically refractory. The clinical outcomes were assessed. The radiographic outcomes, including global and individual segmental range of motion (ROM) at C3-7, and any complications were also analyzed.

Results: Data from a total of 20 patients (mean age: 56 ± 8 years) with an average follow-up of 34 ± 20 months were analyzed. All patients reported improved clinical outcomes compared with that of preoperation, and the ROMs at C3-7 were not only preserved but also trended toward an increase (35 ± 8 vs 37 ± 10 degrees, pre- vs postoperation, P = 0.271) after the 4-level CDA. However, global cervical alignment remained unchanged. There was one permanent C5 radiculopathy, but no other neurological deteriorations or any reoperations occurred.

Conclusion: For these rare but unique indications, 4-level CDA yielded clinical improvement and preserved segmental motility with low rates of complications. Four-level CDA is a safe and effective surgery, maintaining the ROM in patients with primarily disc herniations and mild spondylosis.

Clinical relevance: For patients with mild spondylosis, whose degeneration at the cervical spine is not so severe, CDA is more suitable.

Keywords: anterior cervical discectomy and fusion (ACDF); cervical disc arthroplasty (CDA); four-level; multi-level; range of motion (ROM).

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Conflict of interest statement

Declaration of Conflicting Interests : The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
The preoperative magnetic resonance image of a 53-year-old woman who underwent 4-level CDA. Each level from C3-4 to C6-7 showed significant disc herniation and spinal stenosis that required surgery.
Figure 2
Figure 2
Postoperative flexion/extension radiographs from the patient in Figure 1 at 24 months after surgery. The range of motion at each level was well preserved. Each artificial disc was demonstrated to be well-functioning.
See this image and copyright information in PMC

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