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Multilevel cervical arthroplasty: current evidence. A systematic review.

Andrei F Joaquim¹, K Daniel Riew²

¹Department of Neurology, Discipline of Neurosurgery, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil; and.

Neurosurgical Focus

|February 2, 2017

Summary

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Multilevel cervical disc arthroplasty (CDA) offers motion preservation and comparable safety to anterior cervical discectomy and fusion (ACDF). This procedure is effective for multilevel cervical disc degeneration, even after prior surgery.

Area of Science:

Neurosurgery
Orthopedic Surgery
Spinal Surgery

Background:

Cervical disc arthroplasty (CDA) is effective for single-level cervical radiculopathy/myelopathy.
CDA offers motion preservation and fewer reoperations compared to anterior cervical discectomy and fusion (ACDF).
Multilevel cervical disc degeneration (CDD) is common in patients.

Purpose of the Study:

To systematically review clinical studies on multilevel CDA (2 or more levels).
Evaluate the safety and efficacy of multilevel CDA compared to ACDF.
Assess multilevel CDA outcomes in patients with prior cervical spine surgery.

Main Methods:

Systematic review of MEDLINE database.
Included clinical studies on multilevel CDA; excluded case reports and reviews.

Keywords:

ACDF = anterior cervical discectomy and fusion CASP = clinical adjacent-segment pathology CDA = cervical disc arthroplasty CDD = cervical disc degeneration HO = heterotopic ossification JOA = Japanese Orthopaedic Association MCS = Mental Component Summary NDI = Neck Disability Index ODI = Oswestry Disability Index PCS = Physical Component Summary ROM = range of motion SF-12, SF-36 = 12-Item Short Form Health Survey, 36-Item Short Form Health Survey VAS = visual analog scale anterior cervical discectomy and fusion cervical arthroplasty cervical degenerative disc disease multilevel single level

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Grouped articles by study objective: multilevel CDA vs. ACDF, single-level vs. multilevel CDA, and multilevel CDA post-surgery.

Main Results:

Multilevel CDA is as safe and effective as ACDF, preserving cervical motion.
Multilevel CDA shows clinical effectiveness comparable to single-level procedures with good outcomes.
Higher heterotopic ossification incidence in multilevel CDA was noted but without clinical relevance.

Conclusions:

Current literature supports the use of multilevel CDA for CDD.
Indications for CDA should be more restrictive than for ACDF.
Further independent, prospective studies are needed to confirm CDA's superiority for selected CDD cases.