Medical Necessity of Cervical Artificial Disc Replacement

Clinical Assessment and Indication

A 56-year-old female patient with neck and radiating arm pain, who has failed conservative treatment, is a candidate for cervical artificial disc replacement at C3-4, according to the American College of Radiology, as she presents with symptoms that have not responded to conservative treatments including physical therapy, epidural steroid injections, and activity modification 3
MRI confirms disc herniation at C3-4 that contacts the ventral cord, which corresponds with the patient's symptoms, as reported by the American College of Radiology 3
Flexion-extension X-rays demonstrate no abnormal segmental motion or instability at the affected level, confirming absence of cervical instability, as stated by the Journal of Neurosurgery 4
Documentation confirms no evidence of inflammatory spondyloarthropathy, osteoporosis, previous cervical surgery at C3-4, or infection, according to the Journal of Neurosurgery 4

Cervical arthroplasty is recommended 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, as recommended by the American Association of Neurological Surgeons 1, 2
The patient meets key criteria for cervical disc arthroplasty, including age over 18 years, symptoms corresponding to level of disc degeneration, failure of conservative treatment, and imaging confirmation of pathology, as stated by the American College of Radiology 3

Cervical disc arthroplasty preserves motion at the affected segment, which may reduce stress on adjacent levels, as reported by the American Association of Neurological Surgeons 2, 5
Artificial disc replacement has demonstrated equivalent or better outcomes compared to fusion for cervical radiculopathy, according to the American Association of Neurological Surgeons 1, 2