Medical Necessity of Cervical Disc Arthroplasty at C5-6

Key Criteria for Cervical Disc Arthroplasty

The American College of Neurosurgery recommends cervical disc arthroplasty as an alternative to ACDF in selected patients for control of neck and arm pain, with Class II evidence and a strength of recommendation B 4, 5
To be considered medically necessary, cervical disc arthroplasty must meet specific criteria, including the use of an FDA-approved prosthetic device, at least 6 weeks of comprehensive conservative management, and radiographic confirmation of moderate to severe stenosis and absence of segmental instability 1, 2, 3
The procedure should be performed on patients with signs of neural compression, such as radiculopathy, neurogenic claudication, or myelopathy, corresponding with the level being treated 4, 5
The American Academy of Neurology recommends that patients undergo a thorough evaluation to rule out contraindications, including inflammatory spondyloarthropathy, osteoporosis, previous cervical surgery at the affected level, or infection 1

Cervical arthroplasty preserves motion at the affected segment, potentially reducing stress on adjacent levels 1
The procedure demonstrates equivalent or better outcomes compared to fusion for cervical radiculopathy 1

A 49-year-old male patient presented with left arm pain, diminished sensation, and weakness, and was diagnosed with a small far lateral paracentral disc herniation at C5-6 impinging the nerve root 4, 5
The patient's conservative treatment included medication and epidural injection, resulting in 50-70% relief for 4 days, and a VAS pain score of 8 indicates significant pain 3