Neurospine.  2021 Mar;18(1):34-44. 10.14245/ns.2040454.227.

Revision Surgeries at the Index Level After Cervical Disc Arthroplasty – A Systematic Review

  • 1Department of Neurosurgery, University of Campinas (UNICAMP), Campinas, SP, Brazil
  • 2Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA


To perform a systematic literature review on revision surgeries at the index level after cervical disc arthroplasty (CDA) failure.
A systematic literature review was performed according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Prospective studies on patients who required a secondary surgery after CDA failure were included for analysis. The minimum follow-up for these studies was 5 years.
Out of 864 studies in the original search group, a total of 20 studies were included. From a total of 4,087 patients, 161 patients required a reoperation at the index level. A total of 170 surgeries were performed, as some patients required multiple surgeries. The most common secondary procedures were anterior cervical discectomy and fusion (ACDF) (68%, N = 61) and posterior cervical fusion (15.5%, N = 14), followed by other reoperation (13.3%, N = 12). The associated outcomes for those who required a revision surgery were rarely mentioned in the included literature.
The long-term revision rate at the index level of failed CDA surgery was 3.9%, with a minimum 5-year follow-up. ACDF was the most commonly performed procedure to salvage a failed CDA. Some patients who required a new surgery after CDA failure may require a more extensive salvage procedure and even subsequent surgeries.


Cervical arthroplasty; Index level; Revision; Reoperations; Anterior cervical disc replacement
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