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Evidence-based use of arthroplasty in cervical degenerative disc disease

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Abstract

Introduction

Cervical disc arthroplasty (CDA) was developed to decrease the rate of symptomatic adjacent-level disease while preserving motion in the cervical spine.

Methods

The objectives of this paper are to provide criteria for proper patient selection as well as to present a comprehensive literature review of the current evidence for CDA, including randomized studies, the most recent meta-analysis findings, and long-term follow-up clinical trials as well.

Results

Currently, there are several prospective randomized controlled studies of level I of evidence attesting to the safety and efficacy of CDA in the management of cervical spondylotic disease (CSD) for one- or two-level degenerative diseases. These as well as recent meta-analyses suggest that CDA is potentially similar or even superior to anterior cervical discectomy and fusion (ACDF) when considering several outcomes, including dysphagia and re-operation rate over medium-term follow-up. Less robust studies have also reported satisfactory clinical and radiological outcomes of CDA for hybrid procedures (ACDF combined with CDA), non-contiguous disease, and even for multilevel disease (more than 2 levels).

Conclusions

Based on this evidence we conclude that CDA is a safe and effective alternative to ACDF in properly selected patients for one- or two-level diseases. Defining superiority of specific implants and detailing optimal surgical indications will require further well-designed long-term studies.

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Authors and Affiliations

  1. Department of Neurology, State University of Campinas (UNICAMP), Campinas, SP, Brazil

    Andrei F. Joaquim

  2. Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Melvin C. Makhni

  3. Department of Orthopedic Surgery, Columbia University, New York, NY, USA

    K. Daniel Riew

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  1. Andrei F. Joaquim
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  2. Melvin C. Makhni
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  3. K. Daniel Riew
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Correspondence to Andrei F. Joaquim.

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Joaquim, A.F., Makhni, M.C. & Riew, K.D. Evidence-based use of arthroplasty in cervical degenerative disc disease. International Orthopaedics (SICOT) 43, 767–775 (2019). https://doi.org/10.1007/s00264-018-04281-y

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