This article analyses the current available evidence supporting the expanded indication of cTDR to 3- and 4-level disc disease, either stand-alone or adjacent to fusion, from a less stringent European perspective.ģ- or 4-level cervical disc arthroplasty ACDF Cervical artificial disc Cervical motion preservation Cervical spondylotic myelopathy Degenerative disc disease Multilevel cervical total disc replacement Off-label spine surgery.Ĭopyright © 2021 Elsevier Inc. ![]() However, as cTDR is not immaculate of constraints and failures, its clinical safety and efficacy and cost-effectiveness in multilevel anterior compressive pathology need to be established. Furthermore, multilevel ACDF exacerbates many of the clinical and biomechanical complications related with single-level fusion. It is easily understandable that 3- and 4-level ACDF, with the well-known associated limitations, is not the superlative intervention for a spine segment anatomically designed to provide motion, as cervical spine is. On the other hand, the surgical treatment of more than 2-level disc disease is haunted by an elusive paradox. ![]() According to the published literature, at least nine different cTDR devices share this consistent pattern. Furthermore, from early postoperative to long-term follow-up of 10 to 15 years, cTDR rates superiorly in many primary clinical outcomes. Robust level 1 data from Federal Drug Administration-approved clinical trials demonstrated that cTDR is in any case equally safe and effective compared with ACDF for 1- or 2-level DDD. Model numbers noted in purple are H+C Waterware models (also owned by Global Union/Danze) Faucet. ![]() Cervical total disc replacement (cTDR) is now a firm alternative to anterior cervical discectomy and fusion (ACDF) for degenerative disc disease (DDD).
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