Cervical disc replacement

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bedrock

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Can someone please comment about the specific criteria for cervical disc replacement?

When is it allowed/not allowed? I want to understand when surgeons are following the rules versus not.

1-I know you can’t have major facet OA at that level, but is mild facet OA allowed?
2- you can’t do disc replacement on more than two contiguous levels. But is that only for virgin spine, what about post ACDF?
3-you can’t do disc replacement if unstable level, but what about a very mild spondy of just 1mm?
4- is there a limit how high in the you can do this, particularly in patient with previous cervical surgery? I’ve never seen a C3-C4 disc replacement on top of a c4-c7 fusion, though I’ve seen quite a few C4-C5 disc replacements superior to a C5-C7 ACDF.

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Our surgeons have fairly narrow indications:
- Acute 1 or 2 level isolated disc disease (they quote study with >80% failure rate if DDD, facet disease, spondy)
- Can go as high as C3-4 no problem
- Can do disc replacement adjacent to ACDF but only very specific indications/surgeon discretion.
 
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