Cervical disc arthroplasty (CDA)/total disc replacement (TDR) vs. anterior cervical diskectomy/fusion (ACDF): A review

Nancy E Epstein; Marc A Agulnick

doi:10.25259/SNI_1028_2022

Cervical disc arthroplasty (CDA)/total disc replacement (TDR) vs. anterior cervical diskectomy/fusion (ACDF): A review

Surg Neurol Int. 2022 Dec 2:13:565. doi: 10.25259/SNI_1028_2022. eCollection 2022.

Authors

Nancy E Epstein¹, Marc A Agulnick²

Affiliations

¹ Clinical Professor of Neurosurgery, School of Medicine, State University of NY at Stony Brook, and Editor-in-Chief Surgical Neurology International NY and ℅ Dr. Marc Agulnick 1122 Frankllin Avenue Suite 106, Garden City, NY 11530, USA.
² Assistant Clinical Professor of Orthopedics, NYU Langone Hospital, Long Island, NY, USA. 1122 Franklin Avenue Suite 106 Garden City, NY 11530.

Abstract

Background: We performed a focused review to determine the "non-inferiority", potential superiority, and relative safety/efficacy for performing cervical disc arthroplasty (CDA)/total disc replacement (TDR) in carefully selected patients vs. anterior cervical diskectomy/fusion (ACDF). Notably, CDA/TDR were devised to preserve adjacent level range of motion (ROM), reduce the incidence of adjacent segment degeneration (ASD), and the need for secondary ASD surgery.

Methods: We compared the incidence of ASD, reoperations for ASD, safety/efficacy, and outcomes for cervical CDA/TDR vs. ACDF. Indications, based upon the North American Spine Society (NASS) Coverage Policy Recommendations (Cervical Artificial Disc Replacement Revised 11/2015 and other studies) included the presence of radiculopathy or myelopathy/myeloradiculopathy at 1-2 levels between C3-C7 with/without neck pain. Contraindications for CDA/TDR procedures as quoted from the NASS Recommendations (i.e. cited above) included the presence of; "Infection…", "Osteoporosis and Osteopenia", "Instability…", "Sensitivity or Allergy to Implant Materials", "Severe Spondylosis…", "Severe Facet Joint Arthropathy…", "Ankylosing Spondylitis" (AS), "Rheumatoid Arthritis (RA), Previous Fracture…", "Ossification of the Posterior Longitudinal Ligament (OPLL)", and "Malignancy…". Other sources also included spinal stenosis and scoliosis.

Results: Cervical CDA/TDR studies in the appropriately selected patient population showed no inferiority/ occasionally superiority, reduced the incidence of ASD/need for secondary ASD surgery, and demonstrated comparable safety/efficacy vs. ACDF.

Conclusion: Cervical CDA/TDR studies performed in appropriately selected patients showed a "lack of inferiority", occasional superiority, a reduction in the incidence of ASD, and ASD reoperation rates, plus comparable safety/efficacy vs. ACDF.

Keywords: Adjacent segment disease; Adverse events; Anterior cervical diskectomy/fusion (ACDF); Cervical disc arthroplasty (CDA); Cervical surgery; Comparison; Outcomes; Safety/Efficacy; Secondary surgery/reoperations; Total disc replacement (TDR).

Publication types

Review