New York State Medical Treatment Guidelines for Cervical Artificial Disc Replacement in workers compensation patients

The guidelines established by the New York State Workers Compensation Board are designed to assist healthcare professionals in managing Cervical Artificial Disc Replacement. These directives aim to support physicians and healthcare practitioners in determining the appropriate treatment for individuals experiencing acute fractures or dislocations.

Healthcare professionals specializing in the Cervical Artificial Disc Replacement can rely on the guidance provided by the Workers Compensation Board to make well-informed decisions about the most suitable level of care for their patients.

It is important to stress that these guidelines are not meant to replace clinical judgment or professional expertise. The ultimate decision regarding care for acute fractures and dislocations should involve collaboration between the patient and their healthcare provider.

Cervical Artificial Disc Replacement (Single or Two Level):

This procedure involves placing a prosthetic device into the cervical intervertebral space to maintain natural motion at the treated cervical segment. The choice to use artificial discs is based on the surgeon’s preference and training, and only FDA-approved ones are suitable.

Cervical Arthroplasty is Recommended for Patients Who Meet the Following Criteria:
– Skeletally mature
– Myelopathy or myeloradiculopathy related to central spinal stenosis from one or two levels of degenerative disease (such as herniated disc or spondylotic osteophyte) from C3-4 to C6-7, with or without neck pain.
– Clinically symptomatic cervical radiculopathy and/or myelopathy due to neural compression C3-C7 at one level or two contiguous levels.
– Have not responded to at least 6 months of nonsurgical treatment according to medical guidelines or show signs of progressive clinical deterioration.
– Persistent or recurring symptoms/pain with functional limitations unresponsive to at least 6 months of appropriate conservative treatment according to medical guidelines; AND
– Documented failure of at least 6 consecutive weeks of any two of the following physician-directed conservative treatments:
1) Analgesics, steroids, and/or NSAIDs
2) A structured program of physical therapy
3) A structured home exercise program prescribed by a physical therapist, chiropractic provider, or physician
4) Epidural steroid injections and/or facet injections/selective nerve root block; AND

  • Imaging studies confirm the compression at the level(s) aligning with the clinical findings (MRI or CT); AND
  • No history of neck surgery. Cervical Artificial Disc Replacement isn’t recommended when any of the following situations apply:
    a) Multiple level disease causing symptoms in 3 or more levels
    b) Degenerative disease next to a prior cervical fusion
    c) Infection (either at the implantation site or systemic)
    d) Osteoporosis or osteopenia
    e) Instability
    i) Translation greater than a 3mm difference between lateral flexion-extension views at the affected levels;
    ii) An 11-degree angular difference between lateral flexion-extension views at the symptomatic levels
    f) Sensitivity or allergy to implant materials
    g) Severe spondylosis defined as:
    i) More than 50% disc height loss compared to minimally or non-degenerated levels; OR
    ii) Bridging osteophytes: OR
    iii) Lack of motion on lateral flexion-extension views at the symptomatic site
    h) Severe facet arthropathy
    i) Ankylosing spondylitis
    j) Rheumatoid arthritis
    k) Previous fracture with anatomical deformity
    l) Ossification of the posterior longitudinal ligament (OPLL) m) Active cervical spine malignancy
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