Patient Selection for Cervical Disc Arthroplasty

Cervical intervertebral disc replacement is a current area of much interest. The primary indication for surgery is to remove symptomatic spinal cord or nerve root compression. The intended purpose of the disc prosthesis is to maintain normal physiologic motion at the operated disc level. Anterior cervical disectomy and fusion has an excellent track record in treating radiculopathy and myelopathy. However there are some disadvantages to fusions. The premise of cervical arthroplasty is that by preserving motion it will reduce the incidence of adjacent segment degeneration while avoiding the postoperative restrictions and complications inherent in any fusion. The ideal candidate should have a single- or two-level disc herniation with minimal spondylosis causing symptoms and signs of radiculopathy or myelopathy that have failed nonoperative management. Axial neck pain should not be the chief complaint, and the posterior facets should be free of arthrosis. The bone must be of good quality to allow implant to bone fixation without settling. Cervical arthroplasty is contraindicated in the setting of deformity or instability.