Cervical disk arthroplasty: The new gold standard?

Cervical spondylosis is a broad term that describes pathological degeneration of the cervical spine, leading to axial neck pain, cervical myelopathy, and radiculopathy. Surgical treatments have been developed to address cervical radiculopathy and myelopathy, with the gold standard being anterior cervical diskectomy and fusion (ACDF). However, cervical fusion is associated with many well-known complications, such as pseudarthrosis and adjacent segment disease (ASD). As a result, cervical disk arthroplasty (CDA) was developed as an alternative to fusion for addressing cervical pathology without the risk of pseudarthrosis while preserving mobility and theoretically decreasing the risk of ASD. CDA, however, is uniquely associated with heterotopic ossification formation. While ACDF remains the gold standard, newer studies with long-term follow-up extending up to 20 years have begun to demonstrate superiority of CDA over ACDF, with lower rates of ASD. While the success of CDA is leading to a change in practice patterns, there is still a role for fusion in the management of cervical disease.