Technical Pearls and Learning Curve in Cervical Disc Arthroplasty: A Single-Surgeon Experience of 52 Patients and 100 Levels.

Authors

Hui-Shan Angela Lim, Shilin Wang, Jonathan Yeo, Omar Mohamed Hussein El Dishish, Dalun Leong, Hong Lee Terry Teo, Kumar Dinesh Shree, Michael E Janssen, Zhihong Chew

Published in

International journal of spine surgery. Sep 22, 2026. Epub Sep 22, 2026.

Abstract

Although cervical disc arthroplasty (CDA) is an established motion-preserving alternative to anterior cervical discectomy and fusion (ACDF), literature describing surgical technique and the learning curve remains limited. This study describes key surgical principles refined during a single surgeon's first 100 CDA levels and evaluates the associated learning curve.
A retrospective review was performed of the first 100 CDA levels (52 patients) performed by a fellowship-trained spine surgeon between January 2024 and January 2026. Single-, double-, and triple-level CDA, as well as hybrid CDA-ACDF procedures, were included. Demographic, perioperative, radiographic, and clinical outcome data were collected. Operative duration, length of stay, and postoperative outcomes were analyzed. Risk-adjusted cumulative sum analysis was used to evaluate the surgical learning curve.
Operative duration increased significantly with procedural complexity (P < 0.001), while length of stay also differed according to operation type (P = 0.005). Risk-adjusted cumulative sum analysis demonstrated a learning curve with operative proficiency achieved after approximately 17 cases. Global cervical lordosis improved from 9.5° preoperatively to 15.5° postoperatively. Median modified Japanese Orthopedic Association improved from 16 to 18, Neck Disability Index decreased from 22 to 2, visual analog scale neck pain from 7 to 0, and visual analog scale upper limb pain from 4 to 0 (all P ≤ 0.002). Among patients with preoperative American Spinal Injury Association D status, 83.9% improved to American Spinal Injury Association E, with no neurological deterioration. Complications were uncommon.
CDA can be performed safely and reproducibly with adherence to key technical principles. Progressive improvements in operative efficiency demonstrate a measurable learning curve, while favorable early radiographic and clinical outcomes support the safety and reproducibility of this technique during early adoption.
Recognition of technical pearls and the expected learning curve may facilitate safer implementation of CDA and improve operative efficiency.
Level 4, Retrospective case series.

PMID:
42772847
Bibliographic data and abstract were imported from PubMed on 23 Sep 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.