Artificial Disc Replacement in Cervical Disc Disease

Abstract

Cervical disc disease is one of the most common causes of acquired disability in patients over the age of 50. Cervical Degenerative Disc Disease most commonly is due to age-related changes, but the condition also is affected by lifestyle, genetics, smoking, nutrition, and physical activity. Degenerative changes at the cervical discs and facet joints are ubiquitous in the adult population; these changes are a natural consequence of aging and are asymptomatic in most of the population. Spondylosis refers to these age-related degenera¬tive changes within the spinal column. Most patients who present with cervical spondylosis are older than 40 years. Although most of these age-related degenerative changes remain asymptomatic, they can manifest as three main symp-tom complexes axial neck pain, upper extremity radiculo-pathy, or myelopath or some combination thereof. The conventional treatment for cervical disc disease involves anterior cervical discectomy and fusion (ACDF).It involves removal of the degenerated segment and fusion of the vertebrae so that motion is eliminated. Though ACDF stands as the most common spine surgery performed for the management degenerative disc disease, it is controversial in terms of the conflict it presents between immedi¬ate relief and long term consequences. Despite the success of ACDF, concerns regarding pseudoarthro¬sis, adjacent segment degeneration, and loss of motion at the oper¬ated level have led to the development and adoption of cervical disc arthroplasty (CDA). The underlying hallmark of joint arthroplasty is the ability to preserve motion while maintaining sta¬bility. TDR was found to be more superior than ACDF Therefore, cervical arthroplasty is a safe and effective surgical procedure for treating The topic of disc arthroplasty has invoked very diverse, sometimes outright hostile responses since its inception in Sweden over 50 years ago. Looking back, the adver¬sity by some regarding the Fernstrom implants seems to have been more 'eminence based' preconceptions, rather than based on factual 'evidence' or documented patient safety concerns. After a lengthy period of dormancy, the last 20 years have brought about a resurgence of interest in this technology for the management of patients with unresponsive degenerative disc disease. This resurgence has gone hand-in-hand with refinements of surgical tech¬niques and biomaterials. New health technologies face particular scrutiny because of an increasing resistance of payors to fund new technologies without immediate manifest 'evidence' of their positive im¬pact on outcomes.