Pterion Prep CraniPro VUMC Case Prep
2026-06-27

Case Prep: Cervical Disc Arthroplasty (Cervical Disc Replacement)

Case / Approach Snapshot

One-Liner

[Age]yo [M/F] with [single/two]-level cervical [radiculopathy/myelopathy] at [C_-C_] due to soft disc herniation planned for cervical total disc arthroplasty (motion-preserving).

Figures, Imaging & Video

🎥 Operative video — search operative video on YouTube ▸ · The Neurosurgical Atlas ▸

🧭 Operative approach: Anterior cervical (Smith-Robinson) approach — detailed corridor setup, step-by-step technique & figures

Neurosurgical Atlas · AO Spine / Surgery Reference · Radiopaedia · PubMed Central — operative figures © linked; see media-sources.md

High-Yield Literature

Curated Image Set

Open-access figures are embedded from PubMed Central articles and kept unique to this guide.

Cervical Disc Arthroplasty — Figure 1 Figure 1. Centre of rotation. Source: Assessing in vivo flexion-extension quality of motion after cervical disc arthroplasty: a pilot study — Journal of Spine Surgery 2023; CC BY-NC-ND.

Cervical Disc Arthroplasty — Figure 2 Figure 2. Centre of rotation in (A) C5-C6 and (B) C6-C7 arthroplasty group. (0,0) denotes the centre of superior endplate of caudal vertebra. COR, centre of rotation. Source: Assessing in vivo flexion-extension quality of motion after cervical disc arthroplasty: a pilot study — Journal of Spine Surgery 2023; CC BY-NC-ND.

Cervical Disc Arthroplasty — Figure 3 Figure 3. Average motion fraction throughout the arc of flexion-extension. Source: Assessing in vivo flexion-extension quality of motion after cervical disc arthroplasty: a pilot study — Journal of Spine Surgery 2023; CC BY-NC-ND.

Cervical Disc Arthroplasty — Figure 4 Figure 4. Segmental motion versus global range of motion. FE, flexion-extension; ROM, range of motion. Source: Assessing in vivo flexion-extension quality of motion after cervical disc arthroplasty: a pilot study — Journal of Spine Surgery 2023; CC BY-NC-ND.

Cervical Disc Arthroplasty — Fig. 1 Fig. 1. Anteroposterior (A) and lateral (B) preoperative radiographs demonstrating spondylosis and anterior osteophyte formation at C5–C6. Source: Traumatic Migration of the Bryan Cervical Disc Arthroplasty — Global Spine Journal 2015; open access.

Cervical Disc Arthroplasty — Fig. 2 Fig. 2. Sequential sagittal magnetic resonance image slices (A, B) demonstrating disk–osteophyte complex resulting in moderate central canal narrowing with moderate left and mild right neural… Source: Traumatic Migration of the Bryan Cervical Disc Arthroplasty — Global Spine Journal 2015; open access.

Cervical Disc Arthroplasty — Fig. 3 Fig. 3. Anteroposterior (A) and lateral (B) immediate postoperative radiographs demonstrating well-positioned and appropriately sized single-level Bryan Cervical Disc arthroplasty device at C5-C6. Source: Traumatic Migration of the Bryan Cervical Disc Arthroplasty — Global Spine Journal 2015; open access.

Cervical Disc Arthroplasty — Fig. 4 Fig. 4. Lateral (A), flexion (B), and extension (C) radiographs at 6 weeks postoperatively demonstrating no change in the location or placement of the device, without evidence of migration or… Source: Traumatic Migration of the Bryan Cervical Disc Arthroplasty — Global Spine Journal 2015; open access.

Cervical Disc Arthroplasty — Fig. 5 Fig. 5. Anteroposterior (A) and lateral (B) radiographs at 3 months postoperation demonstrating no change in position of the implant. Source: Traumatic Migration of the Bryan Cervical Disc Arthroplasty — Global Spine Journal 2015; open access.

Cervical Disc Arthroplasty — Fig. 6 Fig. 6. Anteroposterior (A), lateral (B), flexion (C), and extension (D) radiographs at 6 months postoperatively showing migration of the Bryan Cervical Disc device ∼2 mm anteriorly, without… Source: Traumatic Migration of the Bryan Cervical Disc Arthroplasty — Global Spine Journal 2015; open access.

History of Present Illness

Past Medical History

Imaging Review

X-ray (AP, lateral, flexion/extension)

Labs

Neurological Examination

Surgical Planning

Case Logistics, OR Needs & Orders

Position & Approach

Key Surgical Steps

  1. Fluoroscopic level confirmation, transverse incision, platysma, develop interval (carotid sheath lateral, trachea/esophagus medial)
  2. Longus colli elevation, midline marking is critical (prosthesis must be centered for proper articulation)
  3. Complete discectomy and decompression (PLL removal, foraminotomy) — same thoroughness as ACDF
  4. Preserve endplates (do not over-resect — prosthesis relies on endplate integrity; keep parallel, preserve bone)
  5. Maintain uncovertebral joints/lateral anatomy for device centering
  6. Trial and size prosthesis (height, footprint) under fluoroscopy
  7. Center the device precisely in coronal and sagittal planes (off-center → heterotopic ossification, wear, malfunction)
  8. Implant the arthroplasty device, confirm position/motion with fluoroscopy
  9. Closure (no plate; no bone graft needed)

Critical Anatomy & Structures at Risk

  1. Recurrent laryngeal nerve, esophagus, carotid sheath (same as ACDF)
  2. Endplates — preserve for device function
  3. Spinal cord/roots (decompression)
  4. Vertebral arteries (lateral limit)

Equipment

Monitoring

Anesthesia

Potential Complications

  1. Heterotopic ossification (can negate motion preservation)
  2. Device migration/subsidence/malposition
  3. Dysphagia, RLN palsy, esophageal injury (approach)
  4. Persistent/recurrent neural compression, facet pain
  5. Adjacent segment disease (theoretically reduced vs fusion)

Operative Note Template

Preoperative Diagnosis: Cervical [radiculopathy/myelopathy] at [C_-C_] from soft disc herniation

Postoperative Diagnosis: Same

Procedure: Cervical total disc arthroplasty at [C_-C_]

Surgeon / Assistant: Anesthesia: General endotracheal EBL / Fluids: Adjuncts: Fluoroscopy, microscope/loupes Implants: Cervical disc arthroplasty device [type/size] Monitoring: [SSEP/MEP if myelopathic] — stable Complications: None

Indications: [Age]yo [M/F] with single-level [C_-C_] [radiculopathy/myelopathy] from a soft disc with preserved motion and minimal facet arthrosis — an ideal arthroplasty candidate. Risks/benefits/alternatives (incl. ACDF) discussed.

Description of Procedure: After consent and time-out, general anesthesia was induced and the patient positioned supine with the neck neutral (avoiding excess extension). A left anterior Smith-Robinson approach exposed the [C_-C_] disc; the level was confirmed fluoroscopically and the longus colli elevated symmetrically with careful midline marking. A complete discectomy and decompression (including PLL/foraminotomy) was performed while preserving the bony endplates parallel and intact.

The disc space was trialed and the arthroplasty device sized and centered precisely in the coronal and sagittal planes under fluoroscopy, then implanted; position and segmental motion were confirmed. No plate or graft was required.

Hemostasis was obtained and the wound closed in layers. The patient was awakened neurologically [at baseline] and transferred to recovery.

Postoperative Plan

Chief-Level Case Review

Use these as the senior-level mental model for Cervical Disc Arthroplasty (Cervical Disc Replacement):

Common Pimp Questions

Use these to pressure-test preparation for Cervical Disc Arthroplasty (Cervical Disc Replacement):

  1. What neurologic level and root are responsible for the presenting deficit?
  2. What is the decompression target and how will you know it is adequately decompressed?
  3. What instability, deformity, bone-quality, or fusion variable changes the construct?
  4. What vascular, visceral, dural, or neural structure is the main structure at risk?
  5. What postop brace, drain, mobilization, MAP, antibiotic, and DVT plan should be ordered?

Attending Preference Variables

Items that commonly vary by surgeon or institution: