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

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. CLINICAL RELEVANCE: Recognition of technical pearls and the expected learning curve may facilitate safer implementation of CDA and improve operative efficiency. LEVEL OF EVIDENCE: Level 4, Retrospective case series.