A Review of Motion-Preserving Cervical Spinal Implants and Fusion Constructs

Spinal fusion remains a common surgical treatment for degenerative cervical spine pathology. By eliminating segmental motion, fusion alters spinal biomechanics and redistributes mechanical loads to adjacent levels. These changes contribute to adjacent segment degeneration (ASD). Motion-preserving spinal implants have been developed to address these limitations. Cervical disc arthroplasty (CDA) is the most widely used example. Such devices aim to maintain physiologic kinematics while preserving segmental stability. Their biomechanical behavior varies with implant design, material properties, and constraint characteristics. Previous research does not holistically compare fusion with motion-preserving treatments on the spine, resulting in an incomplete understanding of when motion-preserving devices should be considered in treatment over fusion constructs and which specific motion-preserving implants are most appropriate. This narrative review synthesizes experimental, computational, and clinical studies comparing rigid fusion constructs to motion-preserving technologies in the cervical spine. Emphasis is placed on segmental range of motion, load transmission, intradiscal pressure, facet joint forces, and adjacent-segment mechanics. By comparing effectiveness across motion-preserving treatments, alongside their effectiveness to fusion constructs, we found that CDA more closely preserves near-physiologic motion compared to fusion. Taken together, this review underscores the importance of biomechanics-informed implant design for guiding future innovation in spinal implant technologies.