Cervical Motion Preserving Procedures (TDR)

Abstract

Symptomatic cervical degenerative disc disease leading to radiculopathy is a common problem with an incidence of 0.83–1.79 per 1.000 person years. While many episodes of radicular symptoms can be successfully managed by conservative therapy, patients with refractory symptoms or a significant paresis are candidates for a surgical treatment. However, different surgical techniques are available to treat cervical degenerative disc disease, as anterior cervical discectomy without fusion, anterior cervical discectomy with fusion or posterior foraminotomy. Anterior cervical discectomy with fusion as described in the 1960’s (Chap. 3) is currently regarded as the gold standard. Although ACDF provides excellent results with regard to relief of cervical radicular symptoms and neck pain, the loss of motion at the fused level might be associated with secondary problems as accelerated degeneration of adjacent levels. In order to overcome this problem the motion preservation concept developed and cervical disc prostheses maintaining segmental motion became available in the 1990ies. From there on a large selection of different cervical disc prostheses became available which are well studied in comparison to anterior cervical discectomy and fusion in several prospective randomized trials.