Introduction: Cervical arthroplasty

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  • 1 Carolina Neurosurgery and Spine Associates and
  • | 2 Carolinas Medical Center, Charlotte, North Carolina;
  • | 3 Department of Neurological Surgery, University of California, San Francisco, California;
  • | 4 Department of Neurosurgery, Rush Medical Center, Chicago, Illinois; and
  • | 5 Department of Orthopaedic Surgery, Keck Medicine of USC, Los Angeles, California
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There has been a steady evolution of devices for cervical total disc replacement (TDR) over the last decade that has resulted in a surgical technique that closely mimics that for anterior cervical discectomy and fusion (ACDF); disc designs now incorporate novel bio-materials and biomechanics that emphasize quality of motion. The efficacy of cervical arthroplasty has been established with a firm basis of evidence wrought through peer-reviewed published data reported in multiple prospective, randomized, controlled investigational device exemption (IDE) studies,2,5,6,12,18,19,21,27 a number of which now have long-term follow-up.7,23,29 For properly selected patients with 1- and 2-level cervical radiculopathy from C-3 to C-7, cervical arthroplasty is now a standard-of-care treatment, along with ACDF and posterior cervical foraminotomy. There is strong biomechanical and clinical evidence confirming that motion preservation decreases adjacent-level stresses and the rate of radiographic adjacent-level degeneration.1,3,4,8–10,16,20,22,24,28 There are also some data to suggest that arthroplasty positively affects the incidence of clinical adjacent-level reoperation,11,13,17,25,26 but adjacent-level disease is a multifactorial process that deserves continued study. Cervical arthroplasty continues to evolve, with expanded indications14 (there are 2 different FDA-approved devices for 2-level disease), increased adoption by surgeons and payers, and the introduction of new devices15 (2 next-generation devices are currently under IDE study).

This Neurosurgical Focus issue highlights some of the most current information regarding cervical arthroplasty from experienced surgeons not only in the US but from around the world.

References

  • 1

    Baba H, , Furusawa N, , Imura S, , Kawahara N, , Tsuchiya H, & Tomita K: Late radiographic findings after anterior cervical fusion for spondylotic myeloradiculopathy. Spine (Phila Pa 1976) 18:21672173, 1993

    • Search Google Scholar
    • Export Citation
  • 2

    Burkus JK, , Haid RW, , Traynelis VC, & Mummaneni PV: Long-term clinical and radiographic outcomes of cervical disc replacement with the Prestige disc: results from a prospective randomized controlled clinical trial. J Neurosurg Spine 13:308318, 2010

    • Search Google Scholar
    • Export Citation
  • 3

    Chang UK, , Kim DH, , Lee MC, , Willenberg R, , Kim SH, & Lim J: Changes in adjacent-level disc pressure and facet joint force after cervical arthroplasty compared with cervical discectomy and fusion. J Neurosurg Spine 7:3339, 2007

    • Search Google Scholar
    • Export Citation
  • 4

    Coric D, , Cassis J, , Carew JD, & Boltes MO: Prospective study of cervical arthroplasty in 98 patients involved in 1 of 3 separate investigational device exemption studies from a single investigational site with a minimum 2-year follow-up. J Neurosurg Spine 13:715721, 2010

    • Search Google Scholar
    • Export Citation
  • 5

    Coric D, , Nunley P, , Guyer RD, , Musante D, , Carmody CN, & Gordon CR, et al. : Prospective, randomized, multicenter study of cervical arthroplasty: 269 patients from the Kineflex|C artificial disc investigational device exemption study with a minimum 2-year follow-up. J Neurosurg Spine 15:348358, 2011. (Erratum in J Neurosurg Spine 16: 322, 2012)

    • Search Google Scholar
    • Export Citation
  • 6

    Davis RJ, , Kim KD, , Hisey MS, , Hoffman GA, , Bae HW, & Gaede SE, et al. : Cervical total disc replacement with Mobi-C cervical artificial disc compared with anterior discectomy and fusion for treatment of 2-level symptomatic degenerative disc disease: a prospective, randomized, controlled multicenter clinical trial. J Neurosurg Spine 19:532545, 2013

    • Search Google Scholar
    • Export Citation
  • 7

    Delamarter RB, , Murrey D, , Janssen ME, , Goldstein JA, , Zigler J, & Tay BKB, et al. : Results at 24 months from the prospective, randomized, multicenter Investigational Device Exemption trial of ProDisc-C versus anterior cervical discectomy and fusion with 4-year follow-up and continued access patients. SAS J 4:122128, 2010

    • Search Google Scholar
    • Export Citation
  • 8

    DiAngelo DJ, , Roberston JT, , Metcalf NH, , McVay BJ, & Davis RC: Biomechanical testing of an artificial cervical joint and an anterior cervical plate. J Spinal Disord Tech 16:314323, 2003

    • Search Google Scholar
    • Export Citation
  • 9

    Dmitriev AE, , Cunningham BW, , Hu N, , Sell G, , Vigna F, & McAfee PC: Adjacent level intradiscal pressure and segmental kinematics following a cervical total disc arthroplasty: an in vitro human cadaveric model. Spine (Phila Pa 1976) 30:11651172, 2005

    • Search Google Scholar
    • Export Citation
  • 10

    Eck JC, , Humphreys SC, , Lim TH, , Jeong ST, , Kim JG, & Hodges SD, et al. : Biomechanical study on the effect of cervical spine fusion on adjacent-level intradiscal pressure and segmental motion. Spine (Phila Pa 1976) 27:24312434, 2002

    • Search Google Scholar
    • Export Citation
  • 11

    Gao Y, , Liu M, , Li T, , Huang F, , Tang T, & Xiang Z: A meta-analysis comparing the results of cervical disc arthroplasty with anterior cervical discectomy and fusion (ACDF) for the treatment of symptomatic cervical disc disease. J Bone Joint Surg Am 95:555561, 2013

    • Search Google Scholar
    • Export Citation
  • 12

    Heller JG, , Sasso RC, , Papadopoulos SM, , Anderson PA, , Fessler RG, & Hacker RJ, et al. : Comparison of BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion: clinical and radiographic results of a randomized, controlled, clinical trial. Spine (Phila Pa 1976) 34:101107, 2009

    • Search Google Scholar
    • Export Citation
  • 13

    Ishihara H, , Kanamori M, , Kawaguchi Y, , Nakamura H, & Kimura T: Adjacent segment disease after anterior cervical interbody fusion. Spine J 4:624628, 2004

    • Search Google Scholar
    • Export Citation
  • 14

    Kim SW, , Limson MA, , Kim SB, , Arbatin JJ, , Chang KY, & Park MS, et al. : Comparison of radiographic changes after ACDF versus Bryan disc arthroplasty in single and bi-level cases. Eur Spine J 18:218231, 2009

    • Search Google Scholar
    • Export Citation
  • 15

    Lauryssen C, , Coric D, , Dimmig T, , Musante D, , Ohnmeiss DD, & Stubbs HA: Cervical total disc replacement using a novel compressible prosthesis: Results from a prospective Food and Drug Administration–regulated feasibility study with 24-month follow-up. Int J Spine Surg 6:7177, 2012

    • Search Google Scholar
    • Export Citation
  • 16

    Matsunaga S, , Kabayama S, , Yamamoto T, , Yone K, , Sakou T, & Nakanishi K: Strain on intervertebral discs after anterior cervical decompression and fusion. Spine (Phila Pa 1976) 24:670675, 1999

    • Search Google Scholar
    • Export Citation
  • 17

    McAfee PC, , Reah C, , Gilder K, , Eisermann L, & Cunningham B: A meta-analysis of comparative outcomes following cervical arthroplasty or anterior cervical fusion: results from 4 prospective multicenter randomized clinical trials and up to 1226 patients. Spine (Phila Pa 1976) 37:943952, 2012

    • Search Google Scholar
    • Export Citation
  • 18

    Mummaneni PV, , Burkus JK, , Haid RW, , Traynelis VC, & Zdeblick TA: Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion: a randomized controlled clinical trial. J Neurosurg Spine 6:198209, 2007

    • Search Google Scholar
    • Export Citation
  • 19

    Murrey D, , Janssen M, , Delamarter R, , Goldstein J, , Zigler J, & Tay B, et al. : Results of the prospective, randomized, controlled multicenter Food and Drug Administration investigational device exemption study of the ProDisc-C total disc replacement versus anterior discectomy and fusion for the treatment of 1-level symptomatic cervical disc disease. Spine J 9:275286, 2009

    • Search Google Scholar
    • Export Citation
  • 20

    Park DK, , Lin EL, & Phillips FM: Index and adjacent level kinematics after cervical disc replacement and anterior fusion: in vivo quantitative radiographic analysis. Spine (Phila Pa 1976) 36:721730, 2011

    • Search Google Scholar
    • Export Citation
  • 21

    Phillips FM, , Lee JY, , Geisler FH, , Cappuccino A, , Chaput CD, & DeVine JG, et al. : A prospective, randomized, controlled clinical investigation comparing PCM cervical disc arthroplasty with anterior cervical discectomy and fusion. 2-year results from the US FDA IDE clinical trial. Spine (Phila Pa 1976) 38:E907E918, 2013

    • Search Google Scholar
    • Export Citation
  • 22

    Puttlitz CM, , Rousseau MA, , Xu Z, , Hu S, , Tay BK, & Lotz JC: Intervertebral disc replacement maintains cervical spine kinetics. Spine (Phila Pa 1976) 29:28092814, 2004

    • Search Google Scholar
    • Export Citation
  • 23

    Radliff K, , Coric D, & Albert T: Five-year clinical results of cervical total disc replacement compared with anterior discectomy and fusion for treatment of 2-level symptomatic degenerative disc disease: a prospective, randomized, controlled, multicenter investigational device exemption clinical trial. J Neurosurg Spine 25:213224, 2016

    • Search Google Scholar
    • Export Citation
  • 24

    Reitman CA, , Hipp JA, , Nguyen L, & Esses SI: Changes in segmental intervertebral motion adjacent to cervical arthrodesis: a prospective study. Spine (Phila Pa 1976) 29:E221E226, 2004

    • Search Google Scholar
    • Export Citation
  • 25

    Robertson JT, , Papadopoulos SM, & Traynelis VC: Assessment of adjacent-segment disease in patients treated with cervical fusion or arthroplasty: a prospective 2-year study. J Neurosurg Spine 3:417423, 2005

    • Search Google Scholar
    • Export Citation
  • 26

    Upadhyaya CD, , Wu JC, , Trost G, , Haid RW, , Traynelis VC, & Tay B, et al. : Analysis of the three United States Food and Drug Administration investigational device exemption cervical arthroplasty trials. J Neurosurg Spine 16:216228, 2012

    • Search Google Scholar
    • Export Citation
  • 27

    Vaccaro A, , Beutler W, , Peppelman W, , Marzluff JM, , High-smith J, & Mugglin A, et al. : Clinical outcomes with selectively constrained SECURE-C cervical disc arthroplasty: two-year results from a prospective, randomized, controlled, multicenter investigational device exemption study. Spine (Phila Pa 1976) 38:22272239, 2013

    • Search Google Scholar
    • Export Citation
  • 28

    Wigfield C, , Gill S, , Nelson R, , Langdon I, , Metcalf N, & Robertson J: Influence of an artificial cervical joint compared with fusion on adjacent-level motion in the treatment of degenerative cervical disc disease. J Neurosurg 96:1 Suppl 1721, 2002

    • Search Google Scholar
    • Export Citation
  • 29

    Zigler JE, , Delamarter RB, , Murrey D, , Spivak J, & Janssen M: ProDisc-C and anterior cervical discectomy and fusion as surgical treatment for single level cervical symptomatic degenerative disc disease: five-year results of a Food and Drug Administration study. Spine (Phila Pa 1976) 38:203209, 2013

    • Search Google Scholar
    • Export Citation

Disclosures

Dr. Coric reports being a consultant for Medtronic, Stryker, Globus Medical, and Spine Wave; owning stock in Spine Wave and Spinal Kinetics; and receiving royalties from Premia Spine, and RTI Surgical. Dr. Mummaneni reports being a consultant for DePuy Spine, Globus Spine, and Stryker; owning stock in Spinicity/ISD; receiving grants/honoraria from AOSpine; and receiving royalties from Thieme, Taylor and Francis Publishing, Springer, and DePuy Spine. Dr. Wang reports being on the board of directors of the North American Spine Society, AOSpine, and Cervical Spine Research Society and being on the editorial boards of Spine, Journal of the American Academy of Orthopaedic Surgeons, The Spine Journal, Journal of Spinal Disorders and Techniques, Global Spine Journal, and Journal of Orthopaedic Trauma.

Contributor Notes

INCLUDE WHEN CITING DOI: 10.3171/2016.11.FOCUS16491.

  • 1

    Baba H, , Furusawa N, , Imura S, , Kawahara N, , Tsuchiya H, & Tomita K: Late radiographic findings after anterior cervical fusion for spondylotic myeloradiculopathy. Spine (Phila Pa 1976) 18:21672173, 1993

    • Search Google Scholar
    • Export Citation
  • 2

    Burkus JK, , Haid RW, , Traynelis VC, & Mummaneni PV: Long-term clinical and radiographic outcomes of cervical disc replacement with the Prestige disc: results from a prospective randomized controlled clinical trial. J Neurosurg Spine 13:308318, 2010

    • Search Google Scholar
    • Export Citation
  • 3

    Chang UK, , Kim DH, , Lee MC, , Willenberg R, , Kim SH, & Lim J: Changes in adjacent-level disc pressure and facet joint force after cervical arthroplasty compared with cervical discectomy and fusion. J Neurosurg Spine 7:3339, 2007

    • Search Google Scholar
    • Export Citation
  • 4

    Coric D, , Cassis J, , Carew JD, & Boltes MO: Prospective study of cervical arthroplasty in 98 patients involved in 1 of 3 separate investigational device exemption studies from a single investigational site with a minimum 2-year follow-up. J Neurosurg Spine 13:715721, 2010

    • Search Google Scholar
    • Export Citation
  • 5

    Coric D, , Nunley P, , Guyer RD, , Musante D, , Carmody CN, & Gordon CR, et al. : Prospective, randomized, multicenter study of cervical arthroplasty: 269 patients from the Kineflex|C artificial disc investigational device exemption study with a minimum 2-year follow-up. J Neurosurg Spine 15:348358, 2011. (Erratum in J Neurosurg Spine 16: 322, 2012)

    • Search Google Scholar
    • Export Citation
  • 6

    Davis RJ, , Kim KD, , Hisey MS, , Hoffman GA, , Bae HW, & Gaede SE, et al. : Cervical total disc replacement with Mobi-C cervical artificial disc compared with anterior discectomy and fusion for treatment of 2-level symptomatic degenerative disc disease: a prospective, randomized, controlled multicenter clinical trial. J Neurosurg Spine 19:532545, 2013

    • Search Google Scholar
    • Export Citation
  • 7

    Delamarter RB, , Murrey D, , Janssen ME, , Goldstein JA, , Zigler J, & Tay BKB, et al. : Results at 24 months from the prospective, randomized, multicenter Investigational Device Exemption trial of ProDisc-C versus anterior cervical discectomy and fusion with 4-year follow-up and continued access patients. SAS J 4:122128, 2010

    • Search Google Scholar
    • Export Citation
  • 8

    DiAngelo DJ, , Roberston JT, , Metcalf NH, , McVay BJ, & Davis RC: Biomechanical testing of an artificial cervical joint and an anterior cervical plate. J Spinal Disord Tech 16:314323, 2003

    • Search Google Scholar
    • Export Citation
  • 9

    Dmitriev AE, , Cunningham BW, , Hu N, , Sell G, , Vigna F, & McAfee PC: Adjacent level intradiscal pressure and segmental kinematics following a cervical total disc arthroplasty: an in vitro human cadaveric model. Spine (Phila Pa 1976) 30:11651172, 2005

    • Search Google Scholar
    • Export Citation
  • 10

    Eck JC, , Humphreys SC, , Lim TH, , Jeong ST, , Kim JG, & Hodges SD, et al. : Biomechanical study on the effect of cervical spine fusion on adjacent-level intradiscal pressure and segmental motion. Spine (Phila Pa 1976) 27:24312434, 2002

    • Search Google Scholar
    • Export Citation
  • 11

    Gao Y, , Liu M, , Li T, , Huang F, , Tang T, & Xiang Z: A meta-analysis comparing the results of cervical disc arthroplasty with anterior cervical discectomy and fusion (ACDF) for the treatment of symptomatic cervical disc disease. J Bone Joint Surg Am 95:555561, 2013

    • Search Google Scholar
    • Export Citation
  • 12

    Heller JG, , Sasso RC, , Papadopoulos SM, , Anderson PA, , Fessler RG, & Hacker RJ, et al. : Comparison of BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion: clinical and radiographic results of a randomized, controlled, clinical trial. Spine (Phila Pa 1976) 34:101107, 2009

    • Search Google Scholar
    • Export Citation
  • 13

    Ishihara H, , Kanamori M, , Kawaguchi Y, , Nakamura H, & Kimura T: Adjacent segment disease after anterior cervical interbody fusion. Spine J 4:624628, 2004

    • Search Google Scholar
    • Export Citation
  • 14

    Kim SW, , Limson MA, , Kim SB, , Arbatin JJ, , Chang KY, & Park MS, et al. : Comparison of radiographic changes after ACDF versus Bryan disc arthroplasty in single and bi-level cases. Eur Spine J 18:218231, 2009

    • Search Google Scholar
    • Export Citation
  • 15

    Lauryssen C, , Coric D, , Dimmig T, , Musante D, , Ohnmeiss DD, & Stubbs HA: Cervical total disc replacement using a novel compressible prosthesis: Results from a prospective Food and Drug Administration–regulated feasibility study with 24-month follow-up. Int J Spine Surg 6:7177, 2012

    • Search Google Scholar
    • Export Citation
  • 16

    Matsunaga S, , Kabayama S, , Yamamoto T, , Yone K, , Sakou T, & Nakanishi K: Strain on intervertebral discs after anterior cervical decompression and fusion. Spine (Phila Pa 1976) 24:670675, 1999

    • Search Google Scholar
    • Export Citation
  • 17

    McAfee PC, , Reah C, , Gilder K, , Eisermann L, & Cunningham B: A meta-analysis of comparative outcomes following cervical arthroplasty or anterior cervical fusion: results from 4 prospective multicenter randomized clinical trials and up to 1226 patients. Spine (Phila Pa 1976) 37:943952, 2012

    • Search Google Scholar
    • Export Citation
  • 18

    Mummaneni PV, , Burkus JK, , Haid RW, , Traynelis VC, & Zdeblick TA: Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion: a randomized controlled clinical trial. J Neurosurg Spine 6:198209, 2007

    • Search Google Scholar
    • Export Citation
  • 19

    Murrey D, , Janssen M, , Delamarter R, , Goldstein J, , Zigler J, & Tay B, et al. : Results of the prospective, randomized, controlled multicenter Food and Drug Administration investigational device exemption study of the ProDisc-C total disc replacement versus anterior discectomy and fusion for the treatment of 1-level symptomatic cervical disc disease. Spine J 9:275286, 2009

    • Search Google Scholar
    • Export Citation
  • 20

    Park DK, , Lin EL, & Phillips FM: Index and adjacent level kinematics after cervical disc replacement and anterior fusion: in vivo quantitative radiographic analysis. Spine (Phila Pa 1976) 36:721730, 2011

    • Search Google Scholar
    • Export Citation
  • 21

    Phillips FM, , Lee JY, , Geisler FH, , Cappuccino A, , Chaput CD, & DeVine JG, et al. : A prospective, randomized, controlled clinical investigation comparing PCM cervical disc arthroplasty with anterior cervical discectomy and fusion. 2-year results from the US FDA IDE clinical trial. Spine (Phila Pa 1976) 38:E907E918, 2013

    • Search Google Scholar
    • Export Citation
  • 22

    Puttlitz CM, , Rousseau MA, , Xu Z, , Hu S, , Tay BK, & Lotz JC: Intervertebral disc replacement maintains cervical spine kinetics. Spine (Phila Pa 1976) 29:28092814, 2004

    • Search Google Scholar
    • Export Citation
  • 23

    Radliff K, , Coric D, & Albert T: Five-year clinical results of cervical total disc replacement compared with anterior discectomy and fusion for treatment of 2-level symptomatic degenerative disc disease: a prospective, randomized, controlled, multicenter investigational device exemption clinical trial. J Neurosurg Spine 25:213224, 2016

    • Search Google Scholar
    • Export Citation
  • 24

    Reitman CA, , Hipp JA, , Nguyen L, & Esses SI: Changes in segmental intervertebral motion adjacent to cervical arthrodesis: a prospective study. Spine (Phila Pa 1976) 29:E221E226, 2004

    • Search Google Scholar
    • Export Citation
  • 25

    Robertson JT, , Papadopoulos SM, & Traynelis VC: Assessment of adjacent-segment disease in patients treated with cervical fusion or arthroplasty: a prospective 2-year study. J Neurosurg Spine 3:417423, 2005

    • Search Google Scholar
    • Export Citation
  • 26

    Upadhyaya CD, , Wu JC, , Trost G, , Haid RW, , Traynelis VC, & Tay B, et al. : Analysis of the three United States Food and Drug Administration investigational device exemption cervical arthroplasty trials. J Neurosurg Spine 16:216228, 2012

    • Search Google Scholar
    • Export Citation
  • 27

    Vaccaro A, , Beutler W, , Peppelman W, , Marzluff JM, , High-smith J, & Mugglin A, et al. : Clinical outcomes with selectively constrained SECURE-C cervical disc arthroplasty: two-year results from a prospective, randomized, controlled, multicenter investigational device exemption study. Spine (Phila Pa 1976) 38:22272239, 2013

    • Search Google Scholar
    • Export Citation
  • 28

    Wigfield C, , Gill S, , Nelson R, , Langdon I, , Metcalf N, & Robertson J: Influence of an artificial cervical joint compared with fusion on adjacent-level motion in the treatment of degenerative cervical disc disease. J Neurosurg 96:1 Suppl 1721, 2002

    • Search Google Scholar
    • Export Citation
  • 29

    Zigler JE, , Delamarter RB, , Murrey D, , Spivak J, & Janssen M: ProDisc-C and anterior cervical discectomy and fusion as surgical treatment for single level cervical symptomatic degenerative disc disease: five-year results of a Food and Drug Administration study. Spine (Phila Pa 1976) 38:203209, 2013

    • Search Google Scholar
    • Export Citation

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