Biomechanics of Cervical Disc Arthroplasty—A Review of Concepts and Current Technology

• Published in: International journal of spine surgery Vol. 14; no. s2; pp. S14 - S28
• Main Authors: Patwardhan, Avinash G., Havey, Robert M.
• Format: Journal Article
• Language: English
• Published: International Society for the Advancement of Spine Surgery 01-08-2020
• Subjects: Special Issue-Biomechanics
• ISSN: 2211-4599; 2211-4599
• DOI: 10.14444/7087

Activities of daily living require the subaxial cervical spine (C2-C7) to have substantial mobility. Cervical degenerative changes can cause abnormal motions and altered load distribution, leading to pain and limiting the ability of individuals to perform activities of daily living. Anterior cervical discectomy and fusion (ACDF) has been widely used to treat symptomatic cervical spondylosis. Clinical studies have shown cervical disc arthroplasty (CDA) to be a viable alternative to ACDF for the treatment of radiculopathy and myelopathy. The benefits of CDA are based on the premise that preservation of physiologic motions and load-sharing at the treated level would lead to longevity of the index-level facet joints and mitigate the risk of adjacent segment degeneration.
This review article classifies cervical disc prostheses according to their kinematic degrees of freedom and device constraints. Discussion on how these design features may affect cervical motion after implantation will provide the reader with valuable information on how disc prostheses may function clinically.
The ability of a disc prosthesis to work in concert with remaining bony and soft tissue structures to restore physiologic motion and load-sharing is a function of the following design features and surgical factors:
1. Kinematic degrees of freedom—Prostheses that allow translation independent of rotation allow, in theory, the spinal anatomy to dictate segmental motion after CDA potentially restoring physiologic motion and load-sharing. A 6-degrees-of-freedom disc prosthesis may be best equipped to achieve the intended function of CDA.
2. Built-in stiffness—A disc prosthesis with built-in resistance to angular and translational motion may have an advantage in restoring stability to a hypermobile segment without eliminating motion.
3. Surgical factors related to prosthesis implantation may influence cervical segments after CDA. These factors include the amount of disc space distraction caused by the prosthesis, prosthesis placement in the sagittal and coronal planes, and integrity of the soft tissue envelope.