The Orthobullets Podcast Podiums⎪Spine⎪Controversies in Cervical Total Disc Replacement
Jul 30, 2025
Dr. Sravisht Iyer, a leading expert in spine surgery, dives into the heated debates surrounding cervical total disc replacement. He discusses the efficacy of disc replacement versus traditional fusion techniques and the complex factors influencing treatment options for myelopathy. The conversation also touches on the importance of individualized patient care, the challenges of insurance and FDA approvals, and recent research findings that question the safety of expanding disc replacement indications. Iyer's insights highlight the ongoing need for clarity and innovation in spine surgery.
AI Snips
Chapters
Transcript
Episode notes
TDR Data Comes From Strict Trials
- Cervical total disc replacement (TDR) data mainly comes from strict investigational device exemption trials.
- These trials accepted only carefully selected patients, limiting the generalizability of current TDR results.
Myelopathy's Dual Mechanism
- Myelopathy involves static compression and dynamic repetitive microtrauma to the spinal cord.
- This microtrauma may worsen myelopathy and affects decisions on disc replacement use.
Disc Replacement Effective in Myelopathy
- Early studies show disc replacement provides similar clinical improvement as fusion in myelopathy.
- However, sample sizes are small, making it hard to identify the ideal myelopathy patient for TDR.