Cervical Disc Arthroplasty Indications, Challenges & Case Outcomes

Introduction

Degenerative cervical disc disease can significantly impact spinal biomechanics, leading to nerve root or spinal cord compression. While Anterior Cervical Discectomy and Fusion (ACDF) has long been considered the gold standard, modern spine surgery increasingly favors motion preserving techniques such as cervical disc arthroplasty (CDA).

In this case-based review from the Archives of Clinical and Experimental Orthopaedics, we explore the clinical indications surgical challenges, and postoperative outcomes of cervical disc arthroplasty. For more peer-reviewed orthopaedic research and surgical advancements, visit https://www.exporthopaedicjournal.com/index.php/aceo.

Understanding Cervical Disc Arthroplasty

Cervical disc arthroplasty is designed to:

• Preserve motion at the operated segment
• Reduce adjacent segment stress
• Maintain natural cervical biomechanics
• Provide effective neural decompression

Unlike ACDF, which eliminates motion at the treated level, CDA maintains segmental mobility, potentially reducing the risk of adjacent segment degeneration.

The full study is available at: https://doi.org/10.29328/journal.aceo.1001010

Clinical Case Summary

A 38-year-old male presented with:

• Cervical and interscapular pain
• Radiating symptoms to both arms (right > left)
• Sensory changes in the right hand
• Weakness in right thumb extension

Diagnostic Findings

Imaging revealed:

• Decreased C6–C7 intervertebral space
• Right foraminal disc protrusion at C6–C7
• Degenerative disc disease
• No segmental instability

The diagnosis: C6–C7 foraminal disc herniation.

Given the absence of instability and preserved disc height, the patient was scheduled for Total Cervical Arthroplasty (C6–C7).

A detailed surgical discussion can also be explored in our main journal article section on cervical spine interventions.

Surgical Technique Highlights

The procedure followed a standard anterolateral (Smith-Robinson) approach:

• General anesthesia with neurophysiological monitoring
• 3 cm longitudinal incision
• Microsurgical discectomy
• Exposure of dural sac
• Placement of ROTAIO 15×13×7 mm prosthesis
• Fluoroscopic confirmation

Postoperative Outcome

• Strength improved to 5/5
• Complete pain resolution
• Proper implant positioning confirmed by CT
• Discharged after 2 days

The patient underwent short-term collar support and rehabilitation.

Indications and Contraindications

Ideal Candidates

• Young, active adults
• 1–2 level disease (C3–C7)
• Radiculopathy and/or myelopathy
• No facet joint degeneration
• No segmental instability

Absolute Contraindications

• Severe loss of disc height
• Zygapophyseal osteoarthritis
• Significant sagittal/coronal deformity
• Active infection
• Instability

According to the American Academy of Orthopaedic Surgeons (AAOS), patient selection plays a critical role in achieving optimal outcomes in motion preserving spine procedures.

CDA vs ACDF What Does the Evidence Say

Recent systematic reviews report:

• Comparable clinical outcomes between CDA and ACDF
• Reduced secondary procedures in single-level arthroplasty
• Better preservation of motion
• Growing evidence for 2-level and hybrid procedures

Biomechanical studies suggest that arthroplasty reduces intradiscal pressure at adjacent segments, potentially lowering the incidence of adjacent segment disease.

For further clinical comparisons, explore related cervical spine research articles within our orthopaedics category.

Challenges of the Anterolateral Approach

Although considered safe, potential complications include:

• Laryngeal nerve injury
• Vascular injury
• Brachial plexus traction injury
• Esophageal complications

Proper neck positioning, avoidance of excessive traction, and anatomical familiarity are critical for minimizing surgical risks.

Key Takeaways

• Cervical disc arthroplasty preserves motion and spinal biomechanics.
• Appropriate patient selection is crucial.
• Comparable outcomes to ACDF with potential long-term advantages.
• Surgical expertise significantly influences complication rates.

As spine surgery continues to exporthopaedicjournal technologies are redefining treatment strategies for degenerative cervical disease.

Call to Action

Explore more orthopaedic innovations and spine surgery case reports at https://www.exporthopaedicjournal.com/index.php/aceo and join the conversation by sharing your thoughts in the comments below

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