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Single-Level Artificial Disc Replacement for Cervical Degenerative Disc Disease

Focus of Report: Total disc replacement (TDR) for treatment of single-level cervical degenerative disc disease (DDD).

Technology Description: Patients with cervical DDD that continue to experience intractable cervical disc symptoms even after conservative treatment regimens are now presented with various surgical treatment alternatives, including cervical TDR and anterior cervical discectomy and fusion (ACDF), in order to provide relief of radiculopathy and arrest progression of cervical myelopathy. TDR involves the removal of a damaged intervertebral disc and replacement with a prosthetic device; this process preserves some or most of a physiological range of motion.

Health Problem: Cervical DDD can lead to changes in the spinal vertebrae that can destabilize the anterior spinal column and cause radiculopathy (nerve compression leading to arm and neck pain and/or neurological deficit) and myelopathy (compression of the spinal cord). Disc degeneration involves progressive dehydration and fibrosis of the nucleus pulposus, which induces loss of elasticity and disc height, formation of osseous spurs, and eventually extrusion of nucleus tissue.

Patient Population: Adult patients with cervical DDD who present with cervical radiculopathy or myelopathy that has been unresponsive to nonsurgical treatment may be candidates for single-level TDR. Patients often present with coexisting spondylosis or foraminal stenosis; those with less than 3.5 millimeters (mm) translation on flexion-extension lateral radiographs and those without circumferential spinal cord compression are also potential candidates for TDR.

Evidence Base: Eleven randomized controlled trials (RCTs) in 23 publications were identified that examined the effectiveness and safety of single-level artificial cervical TDR compared with ACDF. The reviewed studies (10 fair quality, 1 poor quality) all compared single-level TDR with ACDF. Any findings with regard to combined single-level and multilevel TDR data, or comparisons between single-level and multilevel TDR and ACDF, are beyond the scope of this report. A related and subsequent Hayes report addressing multilevel TDR is currently underway as of the publication date of this report.

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