Rationale: Total disc replacement (TDR) was developed to relieve pain, restore disc height, and maintain the natural motion of the spine. Developers of artificial cervical discs sought to eliminate the problems associated with anterior cervical discectomy and fusion (ACDF).

Technology Description: Patients with cervical degenerative disc disease (DDD) that continue to experience intractable cervical disc symptoms, even after conservative treatment regimens, are now presented with various surgical treatment alternatives, including TDR and ACDF. 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.

Controversy: ACDF causes biomechanical changes in the adjacent segments, including increased shear strains, higher intradiscal pressure, and increased adjacent segment motion, which all have the potential to accelerate the natural progression of DDD. ACDF may be also associated with an increase in adjacent segment disease.

Key Questions:

  • How does single-level cervical TDR compare with ACDF with regard to improvement in signs and symptoms of cervical DDD?
  • How does single-level TDR compare with ACDF with regard to impact on health-related quality of life (HRQOL)?
  • How does single-level TDR compare with ACDF with regard to operative complications and long-term safety, including development of adjacent joint degeneration?
  • Have definitive patient selection criteria been established for single-level TDR?

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