Cervical Disk Arthroplasty: Updated Considerations of an Evolving Technology

Area of Science:

• Orthopedic surgery
• Biomedical engineering
• Spine biomechanics

Background:

• Anterior cervical diskectomy and fusion (ACDF) is a traditional treatment for cervical radiculopathy/myelopathy.
• Concerns about adjacent segment pathology after ACDF have increased interest in cervical disk arthroplasty (CDA).
• CDA aims to preserve motion and replicate natural cervical disk biomechanics.

Purpose of the Study:

• To review the design considerations, clinical outcomes, adverse events, and economic implications of cervical disk arthroplasty (CDA).
• To highlight the importance of patient selection and the need for long-term data on multi-level CDA.
• To discuss the ongoing advancements in CDA technology and evidence-based decision-making.

Main Methods:

• Review of existing clinical studies, including industry-funded and non-industry-funded data.
• Analysis of adverse events reported for CDA, including explanted device analysis.
• Assessment of short-term cost advantages and the need for long-term economic analysis.

Main Results:

• CDA designs focus on replicating natural disk motion with varying levels of constraint and materials.
• Clinical data exist for one- and two-level CDA, with limited data for three- and four-level procedures.
• Adverse events like heterotopic ossification, osteolysis, and device failure have been reported.
• CDA shows short-term cost benefits, but long-term economic tradeoffs require further investigation.

Conclusions:

• Optimizing CDA outcomes requires careful patient selection, especially considering pre-existing cervical spine degeneration.
• Continued research and long-term studies are essential to evaluate the efficacy, safety, and cost-effectiveness of CDA, particularly for multi-level applications.
• Advancements in implant design and evidence-based decision-making are critical for the responsible progression of CDA technology.