Cervical Total Disc Replacement or Fusion - CriteriaThe authors of this study retrospectively reviewed the charts of 167 patients who underwent cervical spine surgery by one of two orthopedic spine surgeons. Indications and contraindications to lumbar total disc replacement, TDR are established and have been well evaluated. Potential candidacy for cervical TDR has not been well evaluated. The authors of the study were interested in the indications and contraindications for cervical total disc replacement. Of the 167 subjects reviewed, 91.6 percent underwent fusion surgery. Non-fusion surgery comprised 8.4 percent of the subjects.
However, 43 percent of the subjects would have met the strict criteria for TDR surgery. Of the 57 percent that had absolute contraindications to cervical TDR, the average number of contraindications was 2.1. If adjacent segment disease was not included in the exclusion criteria, 47 percent of subjects would have been candidates for cervical TDR. In contrast, 0.5 to five percent of persons needing lumbar surgery qualify for consideration of lumbar TDR.
Presently, anterior cervical discectomy and fusion, ACDF is the standard treatment for disc herniation and degenerative disc disease in the cervical spine. However, studies have shown that fusion appears to hasten the onset of adjacent segment degeneration. This often leads to extension of the fusion, which has greater complications. Cervical TDR is designed to maintain more normal motion at the operative and non-operative segments. It does not require bone grafting. The authors support the removal of adjacent segment disease from exclusion criteria for cervical TDR. Results from long-term follow-up studies after cervical TDR are not available.
J.D. Auerbach et al. The prevalence of indications and contraindications to cervical total disc replacement. SpineJ. September 2008. Volume 8. Issue 5. Pp. 711-716.
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