Cervical total disc replacement

Abstract

Summary Cervical total disc replacement (CTDR) has been accepted as a viable option for surgical management of cervical spondylosis or degenerative disc disease. Current indications for CTDR are one- and two-level cervical spondylosis and degenerative disc disease causing radiculopathy or myelopathy that is refractory to medical treatment. Conventionally, these patients could be managed surgically with anterior cervical discectomy and fusion (ACDF) as the standard of care. In recent years, there have been several large-scale, prospective, randomized, and controlled clinical trials that have demonstrated similarly excellent clinical outcomes of both CTDR and ACDF for one-level cervical degenerative disc disease with 5 years of follow-up. Because CTDR allows preservation of segmental motion of the spine and has the potential to reduce the risk of adjacent segment disease (ASD), it has gained popularity in recent years. However, the surgical technique of CTDR is more demanding, and associated complications have been reported. Furthermore, the true effect of CTDR on the incidence of ASD remains uncertain. Therefore, further investigations are required to corroborate favorable long-term results, and whether CTDR can reduce the risk of ASD. Appropriate patient selection and accurate surgical techniques remain the fundamentals of a successful CTDR. The currently available data suggest that CTDR is a safe and effective alternative to ACDF to treat patients with cervical spondylosis or degenerative disc disease and meet the criteria of clinical trials.