Effect of Modified Techniques in Bryan Cervical Disc Arthroplasty

Study Design. A prospective, randomized study of the clinical and radiographic outcomes in patients undergoing single- and 2-level cervical arthroplasty with Bryan cervical disc (Medtronic Sofamor Danek, Memphis, TN). Objective. This study was designed to investigate the modified techniques of cervical arthroplasty with Bryan disc and analyze the clinical and radiologic effects. Summary of Background Data. Aggravation of kyphosis is the known challenge after arthroplasty. Disc insertion angle and overmilling were reported to be factors causing kyphosis. However, few studies have performed methods to avoid these factors. Additionally, translation and length matching of prosthesis seemed to be ignored. There have been no studies regarding the effects of modified techniques for the prevention of these adverse outcomes. Methods. Modified techniques include change in disc insertion, reducing overmilling of endplates, the assurance of the anterior borders at the same horizontal line, and the accurate fitness of prosthesis size. Techniques described in product monograph were applied to 20 patients (control group) and modified techniques were applied to 19 patients (investigational group). Clinical and radiologic (radiograph) follow-ups of all the patients were performed before surgery and after surgery (6 months). Comparisons between the 2 groups in terms of functional spinal unit angle, shell angle, the anteroposterior displacement between the 2 metal shells in the neutral position, and the fitness of prosthesis size were performed. Results. Radiologic outcomes in investigational group were significantly superior to those in control group; clinical outcomes were similar in both groups. Conclusion. The modified techniques can improve the outcomes of the cervical arthroplasty with Bryan disc and prevent the unexpected imbalance and motion of cervical spine.

[1]  Rick C Sasso,et al.  Cervical Kinematics After Fusion and Bryan Disc Arthroplasty , 2008, Journal of spinal disorders & techniques.

[2]  Joseph D. Smucker,et al.  Artificial Disc Versus Fusion: A Prospective, Randomized Study With 2-Year Follow-up on 99 Patients , 2007, Spine.

[3]  S. Yi,et al.  Modified Techniques to Prevent Sagittal Imbalance After Cervical Arthroplasty , 2007, Spine.

[4]  O. Williamson,et al.  Segmental Malalignment With the Bryan Cervical Disc Prosthesis—Contributing Factors , 2007, Journal of spinal disorders & techniques.

[5]  C. Shim,et al.  Early Clinical and Radiologic Outcomes of Cervical Arthroplasty with Bryan Cervical Disc Prosthesis , 2006, Journal of spinal disorders & techniques.

[6]  S. Yi,et al.  Clinical and radiological results following cervical arthroplasty , 2006, Acta Neurochirurgica.

[7]  R. Hurlbert,et al.  Design limitations of Bryan disc arthroplasty. , 2006, The spine journal : official journal of the North American Spine Society.

[8]  G. Pickett,et al.  Kinematic Analysis of the Cervical Spine Following Implantation of an Artificial Cervical Disc , 2005, Spine.

[9]  Michael Y. Wang,et al.  Cervical Arthroplasty with the Bryan Disc , 2005, Neurosurgery.

[10]  J. P. Johnson,et al.  Sagittal alignment and the Bryan cervical artificial disc. , 2004, Neurosurgical focus.

[11]  Paul A. Anderson,et al.  Intervertebral Disc Arthroplasty , 2004, Spine.

[12]  Jason W Haas,et al.  Modeling of the Sagittal Cervical Spine as a Method to Discriminate Hypolordosis: Results of Elliptical and Circular Modeling in 72 Asymptomatic Subjects, 52 Acute Neck Pain Subjects, and 70 Chronic Neck Pain Subjects , 2004, Spine.

[13]  P. McAfee,et al.  Choosing a cervical disc replacement. , 2004, The spine journal : official journal of the North American Spine Society.

[14]  W. Sears,et al.  Effects of a cervical disc prosthesis on segmental and cervical spine alignment. , 2004, Neurosurgical focus.

[15]  G. Pickett,et al.  Early clinical and biomechanical results following cervical arthroplasty. , 2004, Neurosurgical focus.

[16]  Jan Goffin,et al.  Intermediate Follow-up After Treatment of Degenerative Disc Disease With the Bryan Cervical Disc Prosthesis: Single-Level and Bi-Level , 2003, Spine.

[17]  Ricardo Vieira Botelho,et al.  Preliminary clinical experience with the Bryan cervical disc prosthesis. , 2003, Neurosurgery.

[18]  F. Oner,et al.  Complications of Artificial Disc Replacement: A Report of 27 Patients with the SB Charité Disc , 2003, Journal of spinal disorders & techniques.

[19]  Vincent E. Bryan.  Cervical motion segment replacement , 2002, European Spine Journal.

[20]  K. Kaneda,et al.  Correction of cervical kyphosis using pedicle screw fixation systems. , 1999, Spine.

[21]  M. Yoshida,et al.  Axial symptoms and cervical alignments after cervical anterior spinal fusion for patients with cervical myelopathy. , 1999, Journal of spinal disorders.

[22]  T. Albert,et al.  Postlaminectomy Kyphosis , 1998, Spine.

[23]  S. Hukuda,et al.  Anterior cervical plate used in degenerative disease can maintain cervical lordosis. , 1996, Journal of spinal disorders.

[24]  A. Shad,et al.  Anterior correction of cervical kyphotic deformity: effects on myelopathy, neck pain, and sagittal alignment. , 2004, Journal of neurosurgery.