Is Cervical Disk Arthroplasty a Suitable Alternative to Treat Degenerative Cervical Myelopathy?

Abstract

Systemic review. To understand the role of cervical disk arthroplasty in the treatment of cervical myelopathy. The surgical management of degenerative cervical myelopathy (DCM) most frequently involves decompression and fusion, but stiffness introduced by the fusion and adjacent segment degeneration remain problems that can result in significant morbidity. Cervical disk arthroplasty (CDA) is a newer procedure that has been demonstrated to be safe and effective for the management of cervical spine degenerative disk disease, but it has not been traditionally considered as a treatment option for DCM and the use for this indication has not been extensively studied. A systematic review was undertaken using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using a search strategy to query all relevant articles on the use of cervical disk arthroplasty in the setting of cervical myelopathy over a 20-year period (2004-2023). This review examines the literature to assess our current understanding of the appropriateness, safety, and value of CDA in the treatment of DCM. A total of 844 patients received CDA across the 14 studies that met inclusion criteria, with an average of 60.3±40.4 patients per study (range: 11-152 subjects). Featured studies included 5 (35.7%) prospective studies, of which 2 were randomized. All studies had primary outcome measures of disability and/or pain scores, with the Japanese Orthopedic Association myelopathy score and neck disability index as the most commonly assessed. Four (26.7%) studies compared arthroplasty with arthrodesis. Safety of CDA for DCM was found in all studies with improvement in clinical outcome measurements. Cervical disk arthroplasty appears to be a safe and effective surgical option in the management of degenerative cervical myelopathy. Further study is needed to assess if arthroplasty provides clinical improvement in DCM of comparable magnitude and durability as traditional fusion strategies.