Cervical Total Disk Arthroplasty

Area of Science:

• Spine surgery
• Orthopedic biomechanics
• Degenerative disc disease treatment

Background:

• Cervical total disk arthroplasty (TDA) is FDA-approved for 1-2 level cervical disk disease causing myelopathy/radiculopathy.
• Various TDA designs exist, differing in form, function, materials, and in vivo performance.
• Therapeutic goals include pain relief, motion preservation, and mitigating adjacent segment disease (ASDis).

Purpose of the Study:

• To review the current evidence on cervical total disk arthroplasty (TDA).
• To compare TDA designs and their clinical outcomes.
• To evaluate the efficacy of TDA versus anterior cervical discectomy and fusion (ACDF).

Main Methods:

• Review of available clinical evidence and studies on cervical TDA.
• Comparison of different TDA designs (e.g., ball-and-socket, ball-and-trough, elastomeric).
• Analysis of TDA's effectiveness in pain reduction, motion preservation, and prevention of adjacent segment disease (ASDis).

Main Results:

• No single TDA design philosophy is currently favored by clinical evidence.
• Cervical TDA is comparable to anterior cervical discectomy and fusion (ACDF) in reducing pain and neurological symptoms.
• Evidence supporting TDA's reduction of symptomatic adjacent segment disease (ASDis) is unclear and disputed, despite some radiographic evidence.

Conclusions:

• Cervical TDA is a viable option for specific cervical disk conditions, offering pain relief similar to ACDF.
• The long-term clinical benefit of motion preservation and prevention of symptomatic adjacent segment disease (ASDis) with TDA requires further investigation.
• The controversy regarding TDA's superiority over ACDF persists due to unclear evidence on symptomatic adjacent segment disease (ASDis).