PT  - JOURNAL ARTICLE
AU  - Chang, Hsuan-Kan
AU  - Chang, Chih-Chang
AU  - Tu, Tsung-Hsi
AU  - Kuo, Yi-Hsuan
AU  - Wu, Ching-Lan
AU  - Yeh, Mei-Yin
AU  - Kuo, Chao-Hung
AU  - Ko, Chin-Chu
AU  - Fay, Li-Yu
AU  - Huang, Wen-Cheng
AU  - Wu, Jau-Ching
TI  - Four-Level Cervical Disc Arthroplasty
AID  - 10.14444/8603
DP  - 2024 May 21
TA  - International Journal of Spine Surgery
PG  - 8603
4099  - https://www.ijssurgery.com/content/early/2024/05/20/8603.short
4100  - https://www.ijssurgery.com/content/early/2024/05/20/8603.full
AB  - Background Multilevel anterior cervical discectomy and fusion inevitably yields a higher chance of pseudarthrosis or require more reoperations than single-level procedures. Therefore, multilevel cervical disc arthroplasty (CDA) could be an alternative surgery for cervical spondylosis, as it (particularly 3- and 4-level CDA) could preserve more functional motility than single-level disc diseases. This study aimed to investigate the clinical and radiological outcomes of 4-level CDA, a relatively infrequently indicated surgery.Methods The medical records of consecutive patients who underwent 4-level CDA were retrospectively reviewed. These highly selected patients typically had multilevel disc herniations with mild spondylosis. The inclusion criteria were symptomatic cervical spondylotic myelopathy, radiculopathy, or both, that were medically refractory. The clinical outcomes were assessed. The radiographic outcomes, including global and individual segmental range of motion (ROM) at C3-7, and any complications were also analyzed.Results Data from a total of 20 patients (mean age: 56 ± 8 years) with an average follow-up of 34 ± 20 months were analyzed. All patients reported improved clinical outcomes compared with that of preoperation, and the ROMs at C3-7 were not only preserved but also trended toward an increase (35 ± 8 vs 37 ± 10 degrees, pre- vs postoperation, P = 0.271) after the 4-level CDA. However, global cervical alignment remained unchanged. There was one permanent C5 radiculopathy, but no other neurological deteriorations or any reoperations occurred.Conclusion For these rare but unique indications, 4-level CDA yielded clinical improvement and preserved segmental motility with low rates of complications. Four-level CDA is a safe and effective surgery, maintaining the ROM in patients with primarily disc herniations and mild spondylosis.Clinical Relevance For patients with mild spondylosis, whose degeneration at the cervical spine is not so severe, CDA is more suitable.Level of Evidence 4.