Cervical Disc Arthroplasty: A Comprehensive Review of Single-Level, Multilevel, and Hybrid Procedures

Abstract

Study Design:Systematic review.Objectives:Degenerative disc disease and spondylosis resulting in radiculopathy and retrodiscal myelopathy are among the most frequently encountered cervical spinal disorders. Traditionally, anterior cervical discectomy and fusion (ACDF) has successfully achieved neural decompression and restored intradiscal height in these conditions. Unfortunately, nonunion and iatrogenic adjacent segment pathology associated with fusion procedures in the cervical spine has led to an interest in motion-preserving procedures. Cervical disc arthroplasty (CDA) was developed in hopes of preserving cervical biomechanics while mitigating the complications associated with ACDF. Through a systematic review of both published and ongoing studies on single- and multilevel CDA, and hybrid surgeries, we aim to provide evidence for their safety and efficacy in the treatment of various cervical pathologies.Methods:A systematic search of several large databases, including Cochrane Central, PubMed, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry was conducted to identify published studies and ongoing clinical trials on CDA and hybrid surgery.Results:Among the relevant studies reviewed, 3 were randomized controlled trials, 2 systematic reviews, as well as multiple prospective case series, biomechanical studies, and meta-analyses.Conclusion:Over the past decade, multiple high-quality studies have shown that single-level CDA can offer equivalent clinical outcomes with a reduction in secondary procedures and total cost when compared to ACDF. However, more recently there has been an increasing prevalence of 2-level CDA and hybrid surgery. Although the data regarding these multilevel procedures is less robust, it appears that they may be as effective as their single-level counterparts.

The Effectiveness of the Most Used Techniques in Patients With Degenerative Cervical Disease

“…Although this surgical technique is better suited to the condition of the patient, it has disadvantages, such as increased surgical time and intraoperative blood loss, an increased rate of heterotopic ossification, the possibility of vertebral body fractures, dislocation of the implant (if not properly placed), and the possible loss of cervical lordosis. 13,[16][17][18] In addition to choosing the appropriate surgical technique for the patient's clinical and radiographical condition, other factors also influence and are considered predictors of the outcome and quality of life of the patient after the surgical procedure. The factors that predict poor prognosis of surgical outcomes can be divided into two distinct groups: those related to the patient and those related to the imaging examinations (magnetic resonance and computed tomography).…”

Desarrollo mecánico y experimental de un implante discal cervical flexible

“…Está demostrado el beneficio de la artroplastía, aunque en la actualidad el criterio es que podría incluso combinarse con la artrodesis para lograr buenos resultados en los pacientes (15) . Sin embargo, esto no soluciona problemas como la hipermotilidad generada por los implantes dinámicos clásicos en el cual una superficie pivotea sobre la otra (16) .…”

“…Adicionalmente, se debe considerar que la artroplastía cervical tiene por objetivo preservar el movimiento del segmento discal intervenido, por lo que se han desarrollado varios implantes denominados dinámicos, que se basan en dos o más partes móviles que pivotean entre sí y que incluso logran desplazarse en sentido antero-posterior para simular al máximo la dinámica fisiológica de la columna vertebral cervical e incluso su envejecimiento (17,18) . Aunque aún existe discusión respecto a los beneficios obte-nidos por el tratamiento con esta técnica para dos o tres espacios discales simultáneamente (15,19) . Se sabe incluso que no es la técnica más utilizada por grupos de neurocirujanos en el mundo, principalmente debido a los elevados costos, aunque se tiene proyección que esta situación se revertirá en los próximos años, ante la evidencia de los buenos resultados en el corto, mediano y largo plazo (20,21) .…”

Bandscheiben-Prothese bei zervikaler Myelopathie

“…In diesem Fall spricht nichts gegen die ventrale segmentale Dekompression und Implantation zweier Bandscheibenprothesen. Die berichteten klinischen Ergebnisse bei einer bisegmentalen Versorgung mit Bandscheibenprothese sind ebenso als zuverlässig und gut einzustufen [12,18,19]. Eine Versorgung über 3 Etagen ist bei entsprechender MPG-Zulassung möglich [20], aber sicher selten indiziert.…”

“…Auch Hybridkonstrukte sind, ähnlich wie reine Prothesenkonstrukte, in der Lage den biomechanischen Stress auf die angrenzenden Segmente bei multisegmentalen degenerativen Veränderungen zu vermindern. Allerdings zeigt sich diesbezüglich keine klare Evidenz für die eine oder andere Therapie [19].…”