Neurosurg Focus 61(1):E8, 2026
This systematic review and illustrative case evaluate outcomes of multilevel (≥3 levels) cervical artificial disc replacement (C-ADR), synthesizing data from five studies and one clinical example to assess pain relief, functional recovery, range-of-motion preservation, complications, and reoperation rates. The review reports consistent, durable improvements in VAS and NDI scores, preserved segmental and global cervical motion, low revision rates, and primarily transient complications across 3- and 4-level cohorts.
The article compares multilevel C-ADR with anterior cervical discectomy and fusion (ACDF), emphasizing motion-preserving biomechanical advantages that may reduce adjacent segment degeneration. Limitations include sparse, mostly retrospective data, heterogeneous reporting, and limited long-term follow-up, prompting a call for larger prospective trials and extended surveillance for implant longevity and ASD risk.
Objective Characterize outcomes and complications after multilevel (≥ 3 levels) cervical artificial disc replacement (C-ADR), including an illustrative 3-level case for technical discussion.
Methods Systematic review conducted per PRISMA guidelines, querying PubMed and MEDLINE (August 2025) for primary peer-reviewed studies reporting ≥ 3-level C-ADR outcomes, including range of motion (ROM) preservation and complications.
Clinical outcomes Across 5 studies of 3- and 4-level C-ADR, patients had substantial, durable improvements in pain, disability, and quality of life (e.g., neck/arm VAS decreases > 50%) with benefits reported up to 7 years.
Motion preservation Multilevel C-ADR preserved segmental and global cervical ROM, contrasting with near-complete loss of motion reported after multilevel fusion comparators.
Adjacent segment disease No cases of symptomatic adjacent segment degeneration requiring reoperation were reported in the reviewed multilevel C-ADR studies.
Complications/reoperation Complication rates were low and mostly transient; reoperation was required in only 0%–2% of cases across included studies.
Illustrative case A 50-year-old man with progressive cervical myeloradiculopathy underwent 3-level C-ADR (C4–5, C5–6, C6–7) with uncomplicated recovery, immediate symptom relief, and return to unrestricted activity by 6 weeks with preserved motion at 6 months.
Conclusions/limitations 3- and 4-level C-ADR appears safe and effective for appropriately selected patients with durable pain relief and low revision rates, but evidence remains limited (only five stratified studies; largely retrospective) and devices are not FDA-approved for ≥ 3 levels.
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