Cervical Arthroplasty

Operative Planning

Review appropriate imaging including anteroposterior, lateral, and flexion-extension x-rays, magnetic resonance imaging (MRI), computed tomography scan of the cervical spine
Choose arthroplasty device (two are currently approved by the US Food and Drug Administration for single level placement)
- PRESTIGE ST (Sofamor Danek)
  - Stainless steel, ball-and-trough design
  - Vertebral body screws used to fix the position in the interspace
  - Semiconstrained
- PRODISC-C (Synthes, West Chester, PA)
  - Two cobalt chrome alloy endplates and an ultra-high molecular weight polyethylene inlay in a ball-and-socket configuration
  - Central keel for primary fixation
  - Semiconstrained
Patient counseling
- Discuss risks of implant failure, new or residual radiculopathy, migration, subsidence, and reoperation
- Discuss alternatives including fusion or other motion-sparing procedures such as posterior foraminotomy
- Discuss MRI compatibility

See Chapter 94, Anterior Cervical Discectomy/Foraminotomy, as indicated.
Artificial disc implant system (choices listed previously)
To maximize ergonomics, right-handed surgeons may be positioned to the patient’s right.
Endotracheal tube should then be placed to the left corner of the patient’s mouth.
The C-arm fluoroscope is positioned to obtain cross-table lateral cervical x-ray views.

Anesthetic Issues

One to two grams of cefazolin are given preoperatively depending on patient weight (or other appropriate antibiotic of choice).
Dexamethasone may be given before surgery, although it is not mandatory.
Intraoperative neuromonitoring with somatosensory evoked potentials and/or electromyelography is optional.

Positioning and Exposure

See Chapter 94, Anterior Cervical Discectomy/Foraminotomy, as indicated.
Position the patient supine with the neck supported dorsally with a roll.
- The neck should be in a neutral or mildly lordotic position for device placement.
The shoulders are retracted caudally to help with intraoperative fluoroscopic visualization.
- Visualization is important for precise placement of the arthroplasty device.
- The patient’s body habitus should be taken into consideration prior to the procedure.
A transverse right-sided skin incision is made through a preexisting skin crease.
After exposure, a lateral, localizing fluoroscopic x-ray is used to confirm all operative levels.
A self retaining anterior cervical retractor is placed under the elevated edges of the longus colli muscles.
Anteroposterior fluoroscopic x-ray can be used to confirm midline.