Surgical Outcome of Cervical Arthroplasty Using Bryan®

Abstract

Objective : Recently, motion preservation has come to the forefront of emerging technologies in spine surgery. This is the important background information of the emergence of cervical arthroplasty as an alternative to arthrodesis that offers the promise of restoring normal spinal movement and reduces a kinematic strain on adjacent segments. The study was designed to evaluate early surgical outcome and radiological effects of Bryan ® cervical disc prosthesis. Methods : The authors retrospectively reviewed radiographic and clinical outcomes in 52 patients who received the Bryan ® Cervical Disc prosthesis, for whom follow-up data were available. Static and dynamic radiographs were measured by computer to determine the angles formed by the endplates of the natural disc preoperatively, those formed by the shells of the implanted prosthesis, the angle of functional spine unit (FSU), and the C2-7 Cobb angle. The range of motion (ROM) was also determined radiographically, whereas clinical outcomes were assessed using Odom's criteria, visual analogue pain scale (VAS) and neck disability index (NDI). Results : A total of 71 Bryan ® disc were placed in 52 patients. A single-level procedure was performed in 36 patients, a two-level procedure in 13 patients, and a three-level procedure in 3. Radiographic and clinical assessments were made preoperatively. Mean follow-up duration was 29.2 months, ranging from 6 to 36 months. All of the patients were satisfied with the surgical results by Odom's criteria, and showed significant improvement by VAS and NDI score (p < 0.05). The postoperative ROM of the implanted level was preserved without significant difference from preoperative ROM of the operated level (p < 0.05). 97% of patients with a preoperative lordotic sagittal orientation of the FSU were able to maintain lordosis. The overall sagittal alignment of the cervical spine was preserved in 88.5% of cases at the final follow up. Interestingly, preoperatively kyphotic FSU resulted in lordotic FSU in 70% of patients during the late follow up, and preoperatively kyphotic overall cervical alignment resulted in lordosis in 66.6% of the patients postoperatively. Conclusion : Arthroplasty using the Bryan ® disc seemed to be safe and provided encouraging clinical and radiologic outcome in our study. Although the early results are promising, this is a relatively new approach, therefore long-term follow up studies are required to prove its efficacy and its ability to prevent adjacent segment disease.

Cervical artificial disc replacement versus fusion in the cervical spine: a systematic review comparing multilevel versus single-level surgery

“…Both studies reported greater improvement from baseline to 2 years in NDI and VAS neck pain following multilevel C-ADR vs multilevel ACDF;1,2 however, only one study1 reported that the differences were statistically significant, respectively: NDI, 78.0% vs 62.7% ( P  = .02) and 70.5% vs 69.5% ( P  = ns); VAS neck pain, 79.5% vs 63.4 ( P  = .01) and 62.5% vs 58.0% ( P  = not significant).…”

Intervertebral disc joint replacement technology

“…The inclusion of a sheath component to address the clinical concern of wear and corrosion debris (discussed later) is a significant development in the design of orthopedic joint arthroplasty components. The reported results of the bRYaN ® disc have shown favorable clinical outcomes without any evidence of functional degradation including in vivo sheath rupture or excessive wear (garrido et al, 2010;Heller et al, 2009;Kim et al, 2009;Zhang et al, 2013).…”

Cervical Radiculopathy due to Cervical Degenerative Diseases : Anatomy, Diagnosis and Treatment

“…Arthroplasty is rapidly emerging in Korea as an alternative to arthrodesis for cervical radiculopathy and myelopathy, and abundant evidence supports superiority of arthroplasty 3,4,6,28,41,60,61) . Unlike arthrodesis, arthroplasty preserves segmental motion, which may theoretically prevent degenerative changes in segments adjacent to a previous fusion.…”

“…Incidence rates reported for HO range from 0 to 67.1% 28,37,41,42,59,61) . Mehren et al 37) reported that 49.4% of patients had HO grades 2-3, and that motion preservation after arthroplasty can be assured if spontaneous fusion is prevented.…”