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 |
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 |
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.