Advances in the surgical management of cervical degenerative disease

Abstract

Purpose of review: Contemporary surgical management of cervical degenerative disk disease is evolving towards maintaining segmental motion at the operative levels. Anterior cervical surgery, including discectomy or corpectomy and fusion procedures, is considered as the gold standard in surgical management of cervical radiculopathy and myelopathy. Posterior cervical procedures, including foraminotomy, are employed and cervical intervertebral disk prostheses are studied in prospective patient cohorts. This paper reviews the potential benefit of cervical intervertebral disk prostheses compared with anterior cervical discectomy procedures. Recent findings: It has been demonstrated that fusion procedures may result in future segmental degeneration. To decrease segmental breakdown, there has been a trend toward eliminating fusion. This led to developing intervertebral disk arthroplasty. Cervical intervertebral disk arthroplasty represents a potential technique that preserves motion and decreases segmental stresses. Recent studies have shown the benefits of preserving segmental motion. Summary: Prior to lumbar disk arthroplasty, various technologies had been utilized, such as intradiscal electrothermal therapy and artificial nucleus pulposus replacements. None of these has yet been employed in the cervical spine. Lumbar intervertebral disk arthroplasty has been implanted in patients throughout Europe and the United States with fairly good outcomes. Cervical intervertebral disk arthroplasty is being implemented in the United States. Whether this will provide long-lasting outcomes will be validated with long-term studies.