Single-level Bryan cervical disc arthroplasty: evaluation of radiological and clinical outcomes after 18 years of follow-up

OBJECTIVE Several large-scale clinical trials demonstrate the efficacy of 1- and 2-level cervical disc arthroplasty (CDA) for degenerative disc disease (DDD) in the subaxial cervical spine, while other studies reveal that during physiological neck flexion, the C4–5 and C5–6 discs account for more motion than the C3–4 level, causing more DDD. This study aimed to compare the results of CDA at different levels. METHODS After a review of the medical records, 94 consecutive patients who underwent single-level CDA were divided into the C3–4 and non-C3–4 CDA groups (i.e., those including C4–5, C5–6, and C6–7). Clinical outcomes were measured using the visual analog scale for neck and arm pain and by the Japanese Orthopaedic Association scores. Postoperative range of motion (ROM) and heterotopic ossification (HO) were determined by radiography and CT, respectively. RESULTS Eighty-eight patients (93.6%; mean age 45.62 ± 10.91 years), including 41 (46.6%) female patients, underwent a mean follow-up of 4.90 ± 1.13 years. There were 11 patients in the C3–4 CDA group and 77 in the non-C3–4 CDA group. Both groups had significantly improved clinical outcomes at each time point after the surgery. The mean preoperative (7.75° vs 7.03°; p = 0.58) and postoperative (8.18° vs 8.45°; p = 0.59) ROMs were similar in both groups. The C3–4 CDA group had significantly greater prevalence (90.9% vs 58.44%; p = 0.02) and higher severity grades (2.27 ± 0.3 vs 0.97 ± 0.99; p = 0.0001) of HO. CONCLUSIONS Although CDA at C3–4 was infrequent, the improved clinical outcomes of CDA were similar at C3–4 to that in the other subaxial levels of the cervical spine at the approximately 5-year follow-ups. In this Asian population, who had a propensity to have ossification of the posterior longitudinal ligament, there was more HO formation in patients who received CDA at the C3–4 level than in other subaxial levels of the cervical spine. While the type of artificial discs could have confounded the issue, future studies with more patients are required to corroborate the phenomenon.

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Clinical Outcomes of Bryan Cervical Disc Arthroplasty A Prospective, Randomized, Controlled, Single Site Trial With 48-Month Follow-up

Journal of Spinal Disorders & Techniques ◽

10.1097/bsd.0b013e3181bb8568 ◽

2010 ◽

Vol 23 (6) ◽

pp. 367-371 ◽

Cited By ~ 111

Author(s):

Ben J. Garrido ◽

Tarek A. Taha ◽

Rick C. Sasso

Keyword(s):

Clinical Outcomes ◽

Single Site ◽

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Disc Arthroplasty ◽

Randomized Controlled

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Radiological and clinical outcomes of 3-level cervical disc arthroplasty

Journal of Neurosurgery Spine ◽

10.3171/2019.8.spine19545 ◽

2020 ◽

Vol 32 (2) ◽

pp. 174-181 ◽

Cited By ~ 2

Author(s):

Hsuan-Kan Chang ◽

Wen-Cheng Huang ◽

Tsung-Hsi Tu ◽

Li-Yu Fay ◽

Chao-Hung Kuo ◽

...

Keyword(s):

Clinical Outcomes ◽

Large Scale ◽

Japanese Orthopaedic Association ◽

Neck Disability Index ◽

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Disc Arthroplasty ◽

Arm Pain ◽

Estimated Blood Loss

OBJECTIVEOne- and two-level cervical disc arthroplasty (CDA) has been compared to anterior cervical discectomy and fusion (ACDF) in several large-scale, prospective, randomized trials that have demonstrated similar clinical outcomes. However, whether these results would be similar when treating 3-level disc herniation and/or spondylosis has remained unanswered. This study aimed to investigate the differences between 3-level CDA and ACDF.METHODSA series of 50 patients who underwent 3-level CDA at C3–7 was retrospectively reviewed and compared with another series of 50 patients (age- and sex-matched controls) who underwent ACDF at C3–7. Clinical outcomes were measured using the visual analog scale (VAS) for neck and arm pain, the modified Japanese Orthopaedic Association (mJOA) scale, and the Neck Disability Index (NDI). Radiological outcomes included range of motion (ROM) at the index levels. Every patient was evaluated by CT for the presence of fusion in the ACDF group. Also, complication profiles were investigated.RESULTSThe demographics and levels of distribution in both groups were very similar. During the follow-up period of 24 months, clinical outcomes improved (overall and respectively in each group) for both the CDA and ACDF patients when compared with the patients’ preoperative condition. There were essentially few differences between the two groups in terms of neck and arm pain VAS scores, mJOA scores, and NDI scores preoperatively and at 3, 6, 12, and 24 months postoperatively. After the 3-level surgery, the CDA group had an increased mean ROM of approximately 3.4°, at 25.2° ± 8.84°, compared to their preoperative ROM (21.8° ± 7.20°) (p = 0.001), whereas the ACDF group had little mobility (22.8° ± 5.90° before and 1.0° ± 1.28° after surgery; p < 0.001). The mean operative time, estimated blood loss, and complication profiles were similar for both groups.CONCLUSIONSIn this selectively matched retrospective study, clinical outcomes after 3-level CDA and ACDF were similar during the 2-year follow-up period. CDA not only successfully preserved but slightly increased the mobility at the 3 index levels. However, the safety and efficacy of 3-level CDA requires more long-term data for validatation.

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Clinical Outcomes of BRYAN Cervical Disc Arthroplasty: A Prospective, Randomized, Controlled, Multicenter Trial With 24-month Follow-up

Journal of Spinal Disorders & Techniques ◽

10.1097/bsd.0b013e3180310534 ◽

2007 ◽

Vol 20 (7) ◽

pp. 481-491 ◽

Cited By ~ 131

Author(s):

Rick C. Sasso ◽

Joseph D. Smucker ◽

Robert J. Hacker ◽

John G. Heller

Keyword(s):

Clinical Outcomes ◽

Multicenter Trial ◽

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Disc Arthroplasty ◽

Randomized Controlled

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Effects of smoking on cervical disc arthroplasty

Journal of Neurosurgery Spine ◽

10.3171/2018.7.spine18634 ◽

2019 ◽

Vol 30 (2) ◽

pp. 168-174 ◽

Cited By ~ 3

Author(s):

Tsung-Hsi Tu ◽

Chao-Hung Kuo ◽

Wen-Cheng Huang ◽

Li-Yu Fay ◽

Henrich Cheng ◽

...

Keyword(s):

Clinical Outcomes ◽

Smoking Status ◽

Japanese Orthopaedic Association ◽

Neck Disability Index ◽

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Disc Arthroplasty ◽

Arm Pain ◽

Smoking Group

OBJECTIVECigarette smoking can adversely affect bone fusion in patients who undergo anterior cervical discectomy and fusion. However, there is a paucity of data on smoking among patients who have undergone cervical disc arthroplasty (CDA). The present study aimed to compare the clinical and radiological outcomes of smokers to those of nonsmokers following CDA.METHODSThe authors retrospectively reviewed the records of consecutive patients who had undergone 1- or 2-level CDA for cervical disc herniation or spondylosis and had a minimum 2-year follow-up. All patients were grouped into a smoking group, which consisted of those who had consumed cigarettes within 6 months prior to the CDA surgery, or a nonsmoking group, which consisted of those who had not consumed cigarettes at all or within 6 months of the CDA. Clinical outcomes were evaluated according to the visual analog scale for neck and arm pain, Neck Disability Index, Japanese Orthopaedic Association Scale, and Nurick Scale at each time point of evaluation. Radiological outcomes were assessed using radiographs and CT for multiple parameters, including segmental range of motion (ROM), neutral lordotic curve, and presence of heterotopic ossification (HO).RESULTSA total of 109 patients completed at least 2 years of follow-up and were analyzed (mean follow-up 42.3 months). There were 89 patients in the nonsmoking group and 20 in the smoking group. The latter group was younger and predominantly male (both p < 0.05) compared to the nonsmoking group. The two groups had similar improvements in all clinical outcomes after CDA compared to preoperatively. Radiological evaluations were also very similar between the two groups, except for two factors. The smoking group had well-preserved segmental ROM after CDA at an average of 8.1° (both pre- and postoperation). However, while the nonsmoking group remained mobile, segmental ROM decreased significantly (8.2° to 6.9°, p < 0.05) after CDA. There was a trend toward more HO development in the nonsmoking group than in the smoking group, but the difference was without significance (59.6% vs 50.0%, p = 0.43).CONCLUSIONSDuring an average 3.5 years of follow-up after 1- and 2-level CDA, cigarette smokers and nonsmokers had similar improvements in clinical outcomes. Moreover, segmental mobility was slightly better preserved in smokers. Since smoking status did not negatively impact outcomes, CDA may be a reasonable option for selected patients who have smoked.

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