Cervical Disc Arthroplasty (CDA) in the US

Anterior cervical discectomy and fusion (ACDF) is historically the gold standard for treating degenerative disc disease (DDD) in the cervical spine. More recently, cervical disc arthroplasty (CDA) has become more prominent as an alternative to ACDF for treating cervical DDD due to its ability to preserve segmental motion and decrease the risk of adjacent disc disease along with nerve root compression. Long-term clinical studies on single-level treatments have demonstrated superior clinical outcomes for CDA versus ACDF.

FDA Approved Spinal Disc Arthroplasty Procedures

• CDA is currently approved by the FDA for one- and two-level disc pathologies (there are no approved trials for three-level or more cervical pathologies)
• Thoracic SDA has not been approved by the FDA
• Multilevel SDA has been approved in the cervical and lumbar spine, but hasn't been approved in >2 adjacent vertebral levels
• Hybrid arthroplasty (arthroplasty and fusion techniques are combined in alternating fashion at adjacent levels) compared with SDA is currently being studied in clinical trials
• SDA has been approved for usage in one- and two-level lumbar disc pathology with encouraging results (SDA was first approved in the lumbar spine by the FDA on October 26, 2004)
• SDA has not yet been approved for more than two adjacent vertebral levels.

Current Spinal Disc Replacement Summary

SDA (first approved by FDA in 2004) continues to be an alternative to standard decompression and fusion methods for the treatment of DDD. Clinical studies have shown that CDA preserves segmental motion and decreases the risk of adjacent disc disease and nerve root compression when compared to ACDF. Lumbar arthroplasties have also been shown to be safe and effective. The FDA has approved treatment of one- and two-level cervical and lumbar disc pathologies. There are no approved trials for thoracic disc replacement. More recent studies have shown excellent outcomes with three-level or more disc arthroplasties at adjacent levels. New surgical methods investigating the combination of decompression and fusion with arthroplasty have shown comparable results to disc replacement alone. (more data are needed for FDA approval).  Continued surgical studies, utilizing long-term randomized controlled trials or observational studies with larger patient sample sizes, are needed to better evaluate the efficacy of SDA vs. more traditional fusion methods.

Full Article: "Investigational Research: Timeline, Trials, and Future Directions of Spinal Disc Arthroplasty" [Published online 2021 Jul 29. doi: 10.7759/cureus.16739]

For The Latest Spinal Disc Replacement Information

The Bone and Joint Institute of Tennessee’s spine specialists offer personalized surgical and non-surgical treatment for neck and back problems. Whether you’re suffering from trauma, injury, arthritis or other orthopaedic condition, our experts will help relieve pain and restore mobility. We offer the most up-to-date surgical care for spinal conditions, including total disc replacement and minimally invasive spinal surgery. It’s important to note that not all spinal problems require surgery, and we recognize that every patient is different. That’s why our specialists seek out the least invasive and most effective treatment option for each patient. Physical therapy and rehabilitation are also essential elements of spinal care, and we have an experienced team of medical professionals armed with the latest recommendations and tools to help promote healing. For more information or to schedule an appointment, call 615-791-2630.

Bone and Joint Institute of Tennessee Spine Specialists

Additional Educational Videos:

• Cervical Arthroplasty Procedure
• Anterior Cervical Discectomy and Fusion Procedure
• Anterior Lumbar Interbody Fusion Procedure
• Lumbar Microdiscectomy Procedure
• Posterior Lumbar Interbody Fusion Procedure
• Lateral Lumbar Interbody Fusion Procedure
• Laminectomy and Fusion Procedure

*Please note that these are only educational videos and not precisely how the procedure may be performed at the Bone and Joint Institute. Videos are meant to be used as a general explanation of the procedures.

Keywords: disc arthroplasty, artificial disc, degenerative spine disease, lumbar disc degeneration, cervical disc degeneration, interbody device, range of motion, pseudoarthrosis, adjacent segment disease, hybrid