What's New in Spine Surgery
Keith H. Bridwell, MD; Paul A. Anderson, MD; Scott D. Boden, MD; Alexander R. Vaccaro, MD; Jeffrey C. Wang, MD

What's New in the Treatment of the Cervical Spine

As is the case with other areas of the spine, advances in the treatment of the cervical spine have been made in the development of new technology such as disc arthroplasty, in the achievement of a better understanding of surgical morbidity, and in attempts to document outcomes of neurologic recovery. These issues were the focus of annual meetings of both the Cervical Spine Research Society and its European counterpart in 2005.

Disc Arthroplasty

Additional evidence establishing the efficacy of cervical arthroplasty has been reported. The short-term results associated with three different cervical disc prostheses have demonstrated equivalency or slight improvement in comparison with the results of fusion in randomized, controlled trials. The indications for arthroplasty in the ongoing United States Food and Drug Administration Investigational Device Exemption investigations are single-level treatment for radiculopathy or myelopathy in patients with a stable spine. Motion ranging from 7° to 12° has been maintained after arthroplasty. Complications have been few; only rare neurologic complications have been reported.

Additional benefits of arthroplasty may include diminished surgical morbidity and earlier return to function. In one study, the reported rate of reoperation was 2.9% after disc replacement compared with 5.4% after fusion. Compared with patients undergoing fusion, patients undergoing arthroplasty were reported to have a lower rate of reoperation at adjacent levels over the same relatively short (sixteen-month) follow-up period. The most common indication for reoperation in patients managed with disc replacement was inadequate foraminal decompression at the index level. This indicates a need for a meticulous wide uncal decompression when performing arthroplasty reconstruction. Presumably because patients do not require immobilization and are not undergoing the process of achieving fusion, return to work is much earlier after arthroplasty. In a cohort of 976 patients, the return to work was significantly earlier for those who underwent arthroplasty than for those …

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