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CERVICAL DISC ARTHROPLASTY (CDA) - A thought
Dr. P. S. Ramani
Cervical Disc Arthroplasty (CDA) is a motion preserving procedure that provides a potential alternative to fusion. It is believed that such a procedure will maintain normal cervical motion and prevent adjacent segment degeneration. It may improve clinical outcome in comparison to fusion (ACDF).
The earliest Cervical Disc implanted was Bryan Disc. Later, Prodisc-C and PCM became quite popular and has achieved modest success. CDA is a quite a safe and efficacious procedure.
Studies have shown that adjacent segment disc degeneration is not aggravated after CDA. Clinical outcomes have been good and radiographic studies support the effect of motion preservation of the target segment.
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fig 1
CDA with PCM type implant is commonly used
by the author in Mumbai in India |
However, literature also suggests that 12 month follow-up results of CDA are comparable with ACDF and so are 24 months follow-up. However, the utility of Arthroplasty to prevent adjacent segment degeneration can not be conclusively proved at present as 75% of literature available is funded by the industry and of the remaining several authors have financial interest in their respective devices.
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fig 2
De-Puy 'discovery' implant
is sometimes use by the author |
It is only after a few more years that more conclusive evidence may be available.
With the newer technology the CDA device has become extremely simple to be introduced and several suggestions have been made to prevent new bone formation and restrict the mobility of the device. This point in fact has been a point of great concern to prove long term good results with respect to motion preservations at the target segment.
It is generally believed that the CDA technology has offered an excellent to ACDF and will prove to be the procedure of choice in future.
National approval, insurance and the cost effectiveness of the implants will need to be sorted out meaningfully to make CDA implant commonly popular.
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