Cervical Disc Arthroplasty: Evolution, Evidence, and Future Directions in Motion-Preservation Surgery

➢ Cervical disc arthroplasty (CDA) provides clinical outcomes comparable with those of anterior cervical discectomy and fusion (ACDF) for 1-level and 2-level cervical degenerative disc disease (DDD), with durable long-term motion preservation. ➢ Although CDA is associated with lower rates of adjacent-segment pathology compared with ACDF, the absolute risk reduction at longer follow-up is modest and methodological heterogeneity across trials limits definitive conclusions. ➢ Expanded indications including multilevel (≥3-level) CDA, hybrid constructs, and other situations that were previously considered contraindicated during U.S. Food and Drug Administration (FDA) Investigational Device Exemption (IDE) trials have shown promising short-term to intermediate-term results in more recent studies. ➢ As CDA utilization increases, standardized failure reporting and the development of evidence-based revision algorithms are critical to optimize long-term outcomes.