{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T06:57:31Z","timestamp":1778569051597,"version":"3.51.4"},"reference-count":13,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n<jats:title>Background: <\/jats:title>\n<jats:p>We performed a focused review to determine the \u201cnon-inferiority\u201d, potential superiority, and relative safety\/efficacy for performing cervical disc arthroplasty (CDA)\/total disc replacement (TDR) in carefully selected patients vs. anterior cervical diskectomy\/fusion (ACDF). Notably, CDA\/TDR were devised to preserve adjacent level range of motion (ROM), reduce the incidence of adjacent segment degeneration (ASD), and the need for secondary ASD surgery.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st2\">\n<jats:title>Methods: <\/jats:title>\n<jats:p>We compared the incidence of ASD, reoperations for ASD, safety\/efficacy, and outcomes for cervical CDA\/TDR vs. ACDF. Indications, based upon the North American Spine Society (NASS) Coverage Policy Recommendations (Cervical Artificial Disc Replacement Revised 11\/2015 and other studies) included the presence of radiculopathy or myelopathy\/myeloradiculopathy at 1-2 levels between C3-C7 with\/without neck pain. Contraindications for CDA\/TDR procedures as quoted from the NASS Recommendations (i.e. cited above) included the presence of; \u201cInfection\u2026\u201d, \u201cOsteoporosis and Osteopenia\u201d, \u201cInstability\u2026\u201d, \u201cSensitivity or Allergy to Implant Materials\u201d, \u201cSevere Spondylosis\u2026\u201d, \u201cSevere Facet Joint Arthropathy\u2026\u201d, \u201cAnkylosing Spondylitis\u201d (AS), \u201cRheumatoid Arthritis (RA), Previous Fracture\u2026\u201d, \u201cOssification of the Posterior Longitudinal Ligament (OPLL)\u201d, and \u201cMalignancy\u2026\u201d. Other sources also included spinal stenosis and scoliosis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st3\">\n<jats:title>Results: <\/jats:title>\n<jats:p>Cervical CDA\/TDR studies in the appropriately selected patient population showed no inferiority\/ occasionally superiority, reduced the incidence of ASD\/need for secondary ASD surgery, and demonstrated comparable safety\/efficacy vs. ACDF.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st4\">\n<jats:title>Conclusion: <\/jats:title>\n<jats:p>Cervical CDA\/TDR studies performed in appropriately selected patients showed a \u201clack of inferiority\u201d, occasional superiority, a reduction in the incidence of ASD, and ASD reoperation rates, plus comparable safety\/efficacy vs. ACDF.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_1028_2022","type":"journal-article","created":{"date-parts":[[2022,12,2]],"date-time":"2022-12-02T08:04:17Z","timestamp":1669968257000},"page":"565","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Cervical disc arthroplasty (CDA)\/total disc replacement (TDR) vs. anterior cervical diskectomy\/fusion (ACDF): A review"],"prefix":"10.25259","volume":"13","author":[{"given":"Nancy E.","family":"Epstein","sequence":"first","affiliation":[{"name":"Clinical Professor of Neurosurgery, School of Medicine, State University of NY at Stony Brook, and Editor-in-Chief Surgical Neurology International NY and \u2105 Dr. Marc Agulnick 1122 Frankllin Avenue Suite 106, Garden City, NY 11530, USA,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc A.","family":"Agulnick","sequence":"additional","affiliation":[{"name":"Assistant Clinical Professor of Orthopedics, NYU Langone Hospital, Long Island, NY, USA. 1122 Franklin Avenue Suite 106 Garden City, NY 11530."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2022,12,2]]},"reference":[{"key":"10.25259\/SNI_1028_2022\/ref-1","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.jocn.2018.08.050","article-title":"The segmental distribution of cervical range of motion: A comparison of ACDF versus TDR-C","volume":"57","author":"Chang","year":"2018","journal-title":"J Clin Neurosci"},{"key":"10.25259\/SNI_1028_2022\/ref-2","doi-asserted-by":"crossref","first-page":"209","DOI":"10.14245\/kjs.2012.9.3.209","article-title":"Heterotopic ossification following cervical total disc replacement: Iatrogenic or constitutional?","volume":"9","author":"Cho","year":"2012","journal-title":"Korean J Spine"},{"key":"10.25259\/SNI_1028_2022\/ref-3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3171\/2022.7.SPINE22536","article-title":"Prospective, multicenter study of 2-level cervical arthroplasty with a PEEK-on-ceramic artificial disc","author":"Coric","year":"2022","journal-title":"J Neurosurg Spine"},{"key":"10.25259\/SNI_1028_2022\/ref-4","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1302\/0301-620X.100B8.BJJ-2018-0120.R1","article-title":"Total disc replacement versus anterior cervical discectomy and fusion: A systematic review with meta-analysis of data from a total of 3160 patients across 14 randomized controlled trials with both short-and medium-to long-term outcomes","volume":"100B","author":"Findlay","year":"2018","journal-title":"Bone Joint J"},{"key":"10.25259\/SNI_1028_2022\/ref-5","doi-asserted-by":"crossref","first-page":"551","DOI":"10.14444\/6076","article-title":"One-level versus 2-level treatment with cervical disc arthroplasty or fusion: Outcomes up to 7 years","volume":"13","author":"Gornet","year":"2019","journal-title":"Int J Spine Surg"},{"key":"10.25259\/SNI_1028_2022\/ref-6","doi-asserted-by":"crossref","first-page":"725","DOI":"10.4103\/ajns.AJNS_345_20","article-title":"Long-term clinicoradiological outcomes of cervical fusion with polyether ether ketone versus cervical disc arthroplasty in a double-blinded randomized control trial","volume":"16","author":"Gupta","year":"2021","journal-title":"Asian J Neurosurg"},{"key":"10.25259\/SNI_1028_2022\/ref-7","doi-asserted-by":"crossref","first-page":"S96","DOI":"10.1097\/BRS.0b013e31826cb2d6","article-title":"Adjacent segment pathology following cervical motion-sparing procedures or devices compared with fusion surgery: A systematic review","volume":"37","author":"Harrod","year":"2012","journal-title":"Spine (Phila Pa 1976)"},{"key":"10.25259\/SNI_1028_2022\/ref-8","doi-asserted-by":"crossref","first-page":"E4","DOI":"10.3171\/2016.10.FOCUS16354","article-title":"Multilevel cervical arthroplasty: Current evidence. 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