Two-Level Anterior Cervical Discectomy and Fusion Versus Cervical Disc Arthroplasty-Long-Term Evidence Update

Area of Science:

• Spine surgery outcomes
• Cervical spine biomechanics
• Arthroplasty vs. fusion comparison

Background:

• Single-level cervical disc arthroplasty (CDA) is known for motion-sparing benefits over anterior cervical discectomy and fusion (ACDF).
• Limited data exists comparing multilevel ACDF and CDA, despite available midterm and long-term studies.

Purpose of the Study:

• To compare the midterm to long-term efficacy and safety of multilevel cervical disc arthroplasty (CDA) versus anterior cervical discectomy and fusion (ACDF).

Main Methods:

• Review of 3 reports from 2 large, prospective, randomized Food and Drug Administration investigational device exemption trials comparing 2-level CDA and ACDF.
• Inclusion of smaller and shorter-term studies for comprehensive analysis.

Main Results:

• CDA demonstrated superior improvement in Neck Disability Index (NDI) scores, higher patient satisfaction, and fewer secondary surgeries compared to ACDF at 5 years.
• At 7 and 10 years, CDA showed greater improvements in NDI, neck pain, and physical function scores, with lower rates of revision surgery at index and adjacent levels.
• ACDF had higher rates of adverse events and adjacent segment degeneration compared to CDA across multiple studies.

Conclusions:

• Multilevel CDA provides similar to improved patient-reported outcomes compared to ACDF up to 10 years.
• CDA is associated with lower rates of revision surgery at both index and adjacent levels.
• CDA demonstrates a lower incidence of serious adverse device-related events compared to ACDF.