Anterior Cervical Arthroplasty
Mathew Cyriac
John G. Heller
Ideal Indications
Younger patients with soft disk herniations, little segmental spondylosis, and preserved motion at the level of interest (Figures 3-1 and 3-2).
Figure 3-1 ▪ A, B, A 37-year-old male with left C6 radiculopathy caused by a soft disk herniation at C5-6 who failed conservative management.
Radiologic Assessment
Evaluate preoperative x-ray to evaluate for facet joint arthropathy, osteophytes, or listhesis. Significant osteophytes, facet arthropathy, and listhesis are relative contraindications to cervical arthroplasty.
Preoperative magnetic resonance imaging or computed tomography scan can be used to estimate implant size based on depth, width, and height of the disk space.
Special Equipment
Cervical arthroplasty system available from manufacturer
Instrumentation and bone graft for potential conversion to anterior cervical diskectomy with fusion (ACDF) if needed.
Figure 3-2 ▪ A, Computed tomography (CT) myelogram sagittal cut, showing C5-6 soft disk herniation. B, Assessment on parasagittal CT cuts to evaluate for facet arthropathy demonstrates absence of significant arthrosis. C, Axial CT myelogram showing left, paracentral soft disk herniation.
Every arthroplasty patient should be consented for a possible intraoperative conversion to fusion, depending on intraoperative circumstances.
Standard equipment and retractors used for ACDF.
Positioning, Anesthesia, Localization, Approach, and Retractor Placement
Many of these steps are similar to performing ACDF, and the reader is referred to the chapter on ACDF.
Before prepping, ensure a perfect lateral C-arm film can be obtained.
Although rare, inability to adequately radiographically visualize the segment may be a relative contraindication to arthroplasty, requiring conversion to fusion (Figure 3-3).
Localize the disk space with needle, in this case the C5-6 disk (Figure 3-4).
 Figure 3-3 ▪ Lateral xray demonstrates good visualization of the intended operative level C5-6. |
 Figure 3-4 ▪ Needle localization of level. If not sure, it is preferable to place the needle in the vertebral body to avoid disc injury. |
Decompression Techniques
Leksell rongeur to remove anterior osteophytes. Bone wax for bleeders.
Place Caspar pins midline in vertebral body. Precise pin placement is much more important for arthroplasty than ACDF.
Insert distractor over pins.
Insert small Cobb and turn cautiously to gently distract disk space. Two to three clicks on distractor are then applied, depending on the “tightness” of the disk space (Figure 3-5).
No. 15 blade for initial annulotomy.
Start laterally at uncus along the inferior endplate. Cut toward the midline with blade facing medially and come toward the opposite side.Related posts:
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