Cervical arthroplasty for myelopathy—A systematic review

Objective

To perform a systematic literature review of the use of cervical disc replacement for cervical myelopathy.

Methods

A systematic literature review was performed according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Clinical studies on cervical disc replacement surgery for spondylotic cervical myelopathy were included for analysis.

Results

Out of 524 studies in the original search, a total of 13 studies were included. There were 8 studies related to cervical spondylotic myelpathy(CSM). From a total of 561 patients, 685 levels underwent arthroplasty, with an average of 48.6 months of follow-up. On average, Nurik grading system improved 1.5, JOA improved 4.4, and NDI improved 25.1. Mean VAS neck and arm improved 4.4 and 4.5 respectively. Maintained ROM was noted in all studies with one study showing increased global and segmental lordosis. Reoperation was performed in 5 patients whose initial symptoms were not relieved. Complications include 83 cases of paravertebral ossifications (14.8%), 10 dysphagia (1.8%), and 10 levels with anterior migration of the implant, which were treated non-operatively.

Conclusion

At an average of 4 years follow-up, significant improvements in Nurick grade, NDI. JOA, VAS-neck, and VAS-arm pain scores are seen in myelopathy patients undergoing cervical arthroplasty. Retaining range of motion was reported without causing related neurological complications. A large sample size with long-term follow-up studies may be needed to confirm these findings in the future.