The lower plate was redesigned as a shallow ellipsoid saucer to increase the range of translation and rotation. The final product of this project was the Prestige disc comprising a two-piece steel plate that used a ball-in-socket configuration ( Fig. In 1989, the department of medical engineering at Frenchay Hospital in Bristol, England initiated a project on artificial cervical joints. With the success of the lumbar prosthetic device, a new passion for development of a cervical arthroplasty device has emerged. Since then, various other implants have been introduced and are currently in clinical use. SB Charité III, which has been revised twice since 1987, is first popular implant. In this chapter, we briefly discuss the general concept of CTDR while reviewing several critical and controversial issues which need to be settled.Īrtificial discs were developed for the lumbar spine many efforts were made to develop clinically useful artificial discs. However, complete clinical adoption of CTDR requires the settling of a number of controversial issues. Till date, most of these trials suggest that results of CTDR are favorable compared with those of ACDF. Spine surgeons anxiously await the results of various clinical trials, which could solidify the still-theoretical benefits of CTDR. The preservation of segmental motion might prevent or delay ASD process by reducing mechanical stress. Unlike fusion surgery, CTDR is not associated with fusion-related complications like pseudo-arthrosis or graft-related complications. The rationale for CTDR is to preserve segmental motion and maintain normal physiological spinal kinematics. Ĭurrently, cervical total disc replacement (CTDR) using various implants is used as a substitute for cervical fusion surgery. More than 5 years after cervical fusion surgery, up to 50% of patients exhibited adjacent segments degeneration (ASD) on radiographic imaging with symptomatic ASD. Moreover, numerous biomechanical and clinical studies have revealed the evidence of junctional degeneration adjacent to fused levels because of increased biomechanical stress. When an autograft is used, donor site complications including pain or infection can reduce clinical success rates. Symptomatic pseudarthrosis following fusion failure is a main cause of chronic postoperative neck pain and approximately 15% of these cases require revision surgeries. However, there have been some critical issues related to the use of ACDF that remain unresolved. ACDF has become the most popular surgical procedure for disorders of cervical spine. For these reasons, CTDR requires longer-term follow-up data.Īnterior cervical discectomy and fusion (ACDF) is a well-known gold standard surgical procedure for treating degenerative cervical spine diseases. Consequently, it is too early to determine the therapeutic efficacy and cost-effectiveness of CTDR and will require considerable time and studies to provide appropriate answers regarding the same. Additionally, HO, wear debris, multilevel TDR, and hybrid surgery tend to favor CTDR in terms of their effects on outcomes, but the potential of these factors for jeopardizing patients' safety postoperatively and/or to exert harmful effects on surgical outcomes in longer-term follow-up cannot be ignored. Among them, the effect of CTDR on patient outcomes and ASD is theoretically and clinically important however, this issue remains disputable. These issues, including surgical outcomes, adjacent segment degeneration (ASD), heterotopic ossification (HO), wear debris and tissue reaction, and multilevel total disc replacement (TDR) and hybrid surgeries are a common concern of spine surgeons and need to be resolved.
In addition, some controversial issues related to the assessment of clinical outcomes of CTDR remain unresolved. However, CTDR is still a new and innovative procedure with limited indications for clinical application in spinal surgery, particularly, for young patients presenting with soft disc herniation with radiculopathy and/or myelopathy. Since the launch of cervical total disc replacement (CTDR) in the early 2000s, many clinical studies have reported better outcomes of CTDR compared to those of anterior cervical discectomy and fusion.
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