Decompressive surgery for asymptomatic severe cervical spondylosis
Patients without overt neurologic symptoms or signs may be considered for surgery before they develop neurologic abnormalities, following the concept that early, aggressive treatment may prevent neurologic complications (although the risk of such neurologic complications is very low i.e., <0.1%).[12]Rao RD, Gourab K, David KS. Operative treatment of cervical spondylotic myelopathy. J Bone Surg Am. 2006 Jul;88(7):1619-40.
http://www.ncbi.nlm.nih.gov/pubmed/16818991?tool=bestpractice.com
For example, patients may experience severe myelopathy even with minor trauma due to the pre-existing stenosis. An early procedure may prevent this from occurring. Conversely, many patients are asymptomatic. There are no studies of the natural history of the disease to suggest what proportion may become symptomatic, whereas all surgery has known immediate risks and some loss of mechanical function of the cervical spine. Because there are no available data on the likelihood of an asymptomatic patient spontaneously developing cervical myelopathy over time, the consensus at this time is that surgical risks typically outweigh the spontaneous risk of developing neurologic compromise in most asymptomatic patients.
Cervical arthroplasty
Joint replacement of the cervical spine is now FDA-approved for use in anterior cervical procedures for cervical radiculopathy.[8]Rao RD, Currier BL, Albert TJ, et al. Degenerative cervical spondylosis: clinical syndromes, pathogenesis and management. J Bone Joint Surg Am. 2007 Jun;89(6):1360-78.
http://www.ncbi.nlm.nih.gov/pubmed/17575617?tool=bestpractice.com
[20]Bono CM, Ghiselli G, Gilbert TJ, et al; North American Spine Society. An evidence-based clinical guideline for the diagnosis and treatment of cervical radiculopathy from degenerative disorders. Spine J. 2011 Jan;11(1):64-72.
http://www.ncbi.nlm.nih.gov/pubmed/21168100?tool=bestpractice.com
[46]Burkus JK, Haid RW, Traynelis VC, et al. Long-term clinical and radiographic outcomes of cervical disc replacement with the Prestige disc: results from a prospective randomized controlled clinical trial. J Neurosurg Spine. 2010 Sep;13(3):308-18.
http://thejns.org/doi/pdf/10.3171/2010.3.SPINE09513
http://www.ncbi.nlm.nih.gov/pubmed/20809722?tool=bestpractice.com
However, parallel to lumbar arthroplasty and anterior lumbar interbody fusion, these devices may also be effective in treating axial neck pain that can be attributed to cervical degenerative disk disease.[47]Boselie TF, Willems PC, van Mameren H, et al. Arthroplasty versus fusion in single-level cervical degenerative disc disease: a Cochrane review. Spine (Phila Pa 1976). 2013 Aug 1;38(17):E1096-107.
http://www.ncbi.nlm.nih.gov/pubmed/23656959?tool=bestpractice.com
[50]Gao F, Mao T, Sun W, et al. An updated meta-analysis comparing artificial cervical disc arthroplasty (CDA) versus anterior cervical discectomy and fusion (ACDF) for the treatment of cervical degenerative disc disease (CDDD). Spine (Phila Pa 1976). 2015 Dec;40(23):1816-23.
http://www.ncbi.nlm.nih.gov/pubmed/26571063?tool=bestpractice.com
[55]Vaccaro A, Beutler W, Peppelman W, et al. Clinical outcomes with selectively constrained SECURE-C cervical disc arthroplasty: two-year results from a prospective, randomized, controlled, multicenter investigational device exemption study. Spine (Phila Pa 1976). 2013 Dec 15;38(26):2227-39.
http://www.ncbi.nlm.nih.gov/pubmed/24335629?tool=bestpractice.com
Results from two 7-year follow-up studies of randomized controlled trials show superiority in neck disability outcome with arthroplasty, and reduced secondary operations with arthroplasty compared with anterior cervical discectomy and fusion procedures.[56]Janssen ME, Zigler JE, Spivak JM, et al. ProDisc-C total disc replacement versus anterior cervical discectomy and fusion for single-level symptomatic cervical disc disease: Seven-year follow-up of the prospective randomized U.S. Food and Drug Administration investigational device exemption study. J Bone Joint Surg Am. 2015 Nov 4;97(21):1738-47.
http://www.ncbi.nlm.nih.gov/pubmed/26537161?tool=bestpractice.com
[57]Radcliff K, Davis RJ, Hisey MS, et al. Long-term evaluation of cervical disc arthroplasty with the Mobi-C© cervical disc: A randomized, prospective, multicenter clinical trial with seven-year follow-up. Int J Spine Surg. 2017 Nov 28;11:31.
http://www.ncbi.nlm.nih.gov/pubmed/29372135?tool=bestpractice.com