Cervical Total Disc Replacement: Technique – Pitfalls and Pearls

Abstract

Anterior cervical discectomy and fusion (ACDF) is still considered the gold standard for surgical management of cervical spondylosis. The discovery of the impact of fusion on other functional spinal units in the form of adjacent segment disease has led to the development of motion-sparing techniques in cervical spine surgery, such as cervical arthroplasty. A substantial number of different cervical artificial disc implants have been approved for clinical use, some with long-term follow-up data demonstrating the safety and efficacy of the implants in maintaining motion of the index level. However, a significant number of prostheses failed to retain the desired mobility, mostly due to heterotopic ossification and unintentional fusion. Choosing the appropriate implant design, along with meticulous surgical technique, is the most important prerequisite for good surgical results and longevity of implant integrity and function. In this chapter we discuss the evolution of key characteristics of implant design crucial for successful surgery, as well as surgical tips and techniques related to cervical arthroplasty.