- In response to clinical concerns and complications related to fusion, ADR has been proposed as a viable alternative method of managing cervical spondylosis.
- interest in and enthusiasm for this technology has increased in recent years.
- Pros and cons
- potential to preserve motion
- pseudoarthrosis not a concern
- quicker return to routine activities
- hardware failure with potential paralysis
- persistent neck pain from pain originating from facets
- A number of randomized controlled trials comparing CDA with ACDF have shown better functional recovery and reduced the risk of re-operations with CDA. Long-term studies are needed.
- 1966: Fernström first implanted a stainless steel ball bearing in the cervical spine but reported unacceptable rates of device-related complications.
- at that time, ACDF was gaining popularity with reports of great clinical success and therefore interest in motion preserving procedures decreased.
- 1980-90s: a renewed interest in cervical ADR dresurfaced when lumbar disk arthroplasty gained in popularity use in Europe.
- 2002: first report on modern cervical ADR appeared with the premise that it would decrease or prevent adjacent segment disease by maintaining motion
- 2010 to present
- several RCT showing superiority to cervical fusion with regard to
- reoperation rate
- quicker return to work
- single and double level cervical radiculopathy
- single and double level cervical myelopathy
- AP and lateral of cervical spine
- CT scan
- useful to determine positioning and sizing of THA
- required to evaluate central and foraminal stenosis.
- anterior approach to cervical spine
- critical to align center of rotation in both coronal and saggital plane
- especially important in two level CDA
- Hardware failure
- may have catastrophic consequece in retropulsion into spinal canal