**7. Conclusions**

Cervical disc arthroplasty has been one of the most closely scrutinized surgical procedures in the last decade. Short-term prospective clinical studies show cervical disc arthroplasty to be at least the equivalent of ACDF for degenerative pathology. There is some evidence that cervical disc arthroplasty may play a role in diminishing adjacent segment disease. However, the long-term efficacy and safety of cervical disc arthroplasty await further clinical studies.

### **8. References**


Cervical Disc Arthroplasty 513

[24] Huang RC, Girardi FP, Cammisa FP et al. (2003) The implications of constraint in

[25] Hilibrand AS, Carlson GD, Palumbo MA, et al. (1999) Radiculopathy and myelopathy

[26] Mehren, Suchomel et al. (2006) Heterotopic ossification in total cervical artificial disc

[27] Leung C, Casey et al. (2005) Clinical significance of Heterotopic ossification in cervical

[28] McAfee, Cunningham et al. (2003) Classification of Heterotopic ossification (HO) in artificial disk replacement. *Journal of Spinal Disorders and Techniques* 16: 384-9 [29] Mummaneni et al. Clinical and radiographic analysis of cervical disc arthroplasty

[30] Murrey et al. (2009) Results of the prospective, randomized, controlled Food and Drug

[31] Peng CW, Yue WM, Abdul B et al. (2011) Intermediate results of the Prestige LP

[32] Pospiech J, Stolke D, Wilke HJ et al. (1999) Intradiscal pressure recordings in the

[33] Phillips FM, Allen TR, Regen JJ, et al. (2009) Cervical disc replacement in patients with

[34] Pimenta L, McAfee PC, Cappuccino A, et al. (2007) Superiority of multilevel cervical

[35] Penning L. (1978) Normal movements of the cervical spine. *Am J Roentgenol,* 130: 317-

[36] Raposo J, Darden BV. (publication pending) Biomechanics of cervical disc arthroplasty.

[37] Riew KD, Buchowski JM, Sasso R, Zdeblick T, Metcalf NH, Anderson PA. (2008)

[38] Robinson R, Smith G. (1955): Anterolateral cervical disc removal and interbody fusion

[39] Sola S, Hebecker R, Knoop M et al. (2005 suppl) Bryan cervical disc prosthesis- three

[40] Tumialan LM and Gluf, Wm. (2011) Progressive vertebral body osteolysis after cervical

myelopathy. *Journal of Bone and Joint-A*, Vol. 90: pp 2354-2364

years follow-up. *European Spine Journal,* 14:38

arthroplasty. *Spine,* 36(14):973-8

for cervical disc syndrome. *Bull. John Hopkins Hospital,* 96:223-224

symptomatic cervical disc disease. *Spine Journal*, Vol. 9, pp 275-286

417

discussion 763

(6) 556-565

326

Wilkins

*Bone and Joint Surgery Am*, 81: 519-528

replacement. *Spine,* 31(24) 2802-2806

*Neurosurgery –Spine*, Vol. 6, pp 198-209

year follow-up. *Spine,* 36 (2): E 105-111

cervical spine. *Neurosurgery*, 44: 379-384.

prostheses. *Spine,* 32 (12) 1337-1344

lumbar total disc replacement. *Journal of Spinal Disorders and Techniques,* 16(4): 412-

at segments adjacent to the site of a previous anterior cervical arthrodesis. *Journal of* 

disc replacement: a prospective multi-center clinical trial. *Neurosurgery,* 57:759-631

compared with allograft fusion: A randomized controlled trial*. Journal of* 

Administration Investigational Device Exemption Study of the ProDisc-C total disc replacement versus anterior discectomy and fusion for the treatment of one level

cervical disc replacement: clinical and radiological analysis with minimum two-

and without previous adjacent level fusion surgery: A prospective study. *Spine,* 34

arthroplasty outcomes versus single level outcomes: 229 consecutive PCM

*The Cervical Spine, 5th Edition*. Editor Edward Benzel, Lippincott, Williams and

Cervical disc arthroplasty compared with arthrodesis for the treatment of


[8] Cloward RD. (1961) Treatment of acute fractures and fracture dislocations of cervical

[9] Cummins BH, Robertson JT, Gill SS. (1998) Surgical experience with an implanted

[10] Delamarter RB, Pradhan BB. (2004) Indications for cervical spine prostheses, early

[11] Delamarter RB, Murrey D, Janssen MI et al. (2010) Results of 24 months from the

[12] DiAngelo DJ, Robertson JT, Metcalf NH et al. (2003) Biomechanical testing of an

[13] Dmitriev AE, Cunningham BW, Hu N et al. (2005) Adjacent level intradiscal pressure

[14] Dvorak J, Panjabi MM, Grob D et al. (1993) Clinical validation of functional flexion/extension radiographs of the cervical spine. *Spine,* 18:120-127 [15] Dvorak J, Panjabi MM, Novotny JE et al. (1991) In vivo flexion/extension of the normal

[16] Eck JC, Humphreys SC, Lim T, et al. (2002) Biomechanical study on the effect of

[17] Goffin J, VanLoo J, VanCalenbergh F et al. (2010) A clinical analysis of 4-6 year follow-

[18] Goffin J, Geusens E, Vantomme N, et al. (2004) Long-term follow-up after

[19] Goffin J, Casey A, Kehr P, et al. (2002) Preliminary clinical experience with the Bryan

[20] Goffin J, Van Loon J, VanCalenbergh F, et al. (1995) Long-term results after anterior

[22] Gore DR, Sepic SB. (1984) Anterior cervical fusion for degenerated or protruded discs:

[23] Heller JG, Sasso RC, Papadopoulos SM, Anderson PA, Fessler RG et al. (2009)

the cervical spine. *Journal of Spinal Disorders and Techniques,* 8: 500-508 [21] Gore DR, Sepic SB. (1998) Anterior discectomy and fusion for painful cervical disc

A review of one hundred forty-six patients. *Spine,* 9:667-71

decompression and fusion. *Spine,* 34(2) 101- 107

artificial cervical joint. *Journal of Neurosurgery,* 88: 943-948

experiences with ProDisc-C in the USA. *Spine Art*, 1:7-9

and continued access patients. *SAS Journal,* 4: 122-128

human cadaveric model. *Spine,* 30: 1165-1172

cervical spine. *Journal of Orthop Res,* 9: 828-834

cervical disc prosthesis. *Neurosurgery*, 51(3) 840-845.

209

*Tech,* 16(4): 314-323

*Spine,* 27: 2431-2434

17(2) 79-85

2047-2051

J *Neurosurgery Spine,* 12 (3) 261-9

spine by vertebral body fusion: a report of cases. *Journal of Neurosurgery*, 118: 205-

prospective, randomized, multicenter investigation device exemption trial of ProDisc-C versus anterior cervical discectomy and fusion with 4-year follow-up

artificial cervical joint and an anterior cervical plate. *Journal of Spinal Disorders and* 

and segmental kinematics following a cervical total disc arthroplasty: An in vitro

cervical spine fusion on adjacent level intradiscal pressure and segment motion.

up results after cervical disc replacement using the Bryan Cervical Disc Prosthesis.

interbody fusion of the cervical spine. *Journal of Spinal Disorders and Techniques,*

cervical fusion and osteosynthetic stabilization for fractures and/or dislocation of

disease: a report of 50 patients with an average follow-up of 21 years. *Spine,* 23:

Comparison of Bryan Cervical Disc Arthroplasty with anterior cervical


**24** 

*USA* 

**Lumbar Spinal Arthroplasty:** 

*Chicago Back Institute, Swedish Covenant Hospital, N. Francisco, Chicago, IL* 

Lumbar spinal arthroplasty was first reported in clinical settings more than 10 years ago by Griffith et al 1. This early experience was acquired with the first lumbar artificial disc, the CHARITÉ I, in patients with degenerative disc disease. Since that time, a randomized controlled trial comparing arthroplasty with the CHARITÉ Artificial Disc vs. anterior lumbar interbody fusion with the BAK Cage and iliac crest bone was completed. Multiple other lumbar arthroplasty devices have been developed subsequent to the CHARITÉ and

Unlike other spinal medical devices, lumbar discs are required by the Food and Drug Administration to complete randomized controlled trials (RCT) prior to market approval in the United States. As a result, lumbar arthroplasty devices have undergone more scrutiny and clinical evaluation than any other spinal medical devices. Specifically, a new device, the ProDisc-L, was granted FDA approval in 2006 and was described in a recent peer-review publication2. In addition, the Maverick Total Disc Arthroplasty System (Medtronic Sofamor Danek), Kineflex Lumbar Disc (SpinalMotion), and FlexiCore Intervertebral Disc (SpineCore/Stryker) lumbar discs have both completed their randomized enrollments and

All these ongoing and completed randomized clinical trials have generated a large body of evidence on the safety and efficacy of arthroplasty for lumbar spine in clinical applications

The safety and efficacy of arthroplasty are not the only parameters discussed in the >60 clinical papers published over the last 6 years. In fact, significant insights were developed in the impact of arthroplasty on sagittal alignment and motion, possible adverse events and reoperation, as well as optimal patient selection and indication. Surgical technique and health economics papers have also been generated in an effort to fully understand the clinical and societal impact of this new technology. This review paper is aimed at providing

A search was conducted on the OVID and COCHRANE Library database to collect all clinical data relevant to spinal arthroplasty. Specifically, the following keywords were used:

**1. Introduction** 

are undergoing or completing clinical trials.

and, in many cases, in Level-1 publications.

**2. Materials and methods** 

are currently in continued access (non-randomized) mode.

an overview of all the existing clinical data related to spinal arthroplasty.

**Clinical Experience** 

Fred H. Geisler

[41] Yi S, Kim KN, Yang MS, et al. (2010) Difference in occurrence of Heterotopic ossification according to prosthesis type in the cervical artificial disc replacement. *Spine,* 35(16):1556-1561
