Design limitations of Bryan disc arthroplasty

Fong, Shee Yan; DuPlessis, Stephan; Casha, Steven; Hurlbert, R. John

doi:10.1016/j.spinee.2006.01.007

Cited by 79 publications

(79 citation statements)

References 13 publications

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“…Despite these excellent success rates, artificial cervical disc implants may fail from device-related complications such as dislocation, subsidence, vertebral body fracture, heterotopic ossification, spontaneous fusion and device wear [2]. Heterotopic ossification [10], delayed fusion around cervical disc prosthesis [11], asymmetric endplate preparation resulting in postoperative kyphosis, and reduction of vertebral body height [12] have all been encountered in the previous reports. Mehren et al reported an ossification rate of 49.4 % one year after implantation of disc device and suspected an even higher rate of spontaneous fusion after long-term follow-up [13].…”

Section: Discussionmentioning

confidence: 99%

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Footprint mismatch in total cervical disc arthroplasty

et al. 2012

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Purpose Cervical disc arthroplasty has become a commonplace surgery for the treatment of cervical radiculopathy and myelopathy. Most manufacturers derive their implant dimensions from early published cadaver studies. Ideal footprint match of the prosthesis is essential for good surgical outcome. Methods We measured the dimensions of cervical vertebrae from computed tomography (CT) scans and to assess the accuracy of match achieved with the most common cervical disc prostheses [Bryan (Medtronic), Prestige LP (Medtronic), Discover (DePuy) Prodisc-C (Synthes)]. A total of 192 endplates in 24 patients (56.3 years) were assessed. The anterior-posterior and mediolateral diameters of the superior and inferior endplates were measured with a digital measuring system. Results Overall, 53.5 % of the largest device footprints were smaller in the anterior-posterior diameter and 51.1 % in the mediolateral diameter were smaller than cervical endplate diameters. For levels C5/C6 and C6/C7 an inappropriate size match was noted in 61.9 % as calculated from the anteroposterior diameter. Mismatch at the center mediolateral diameter was noted in 56.8 %. Of the endplates in the current study up to 58.1 % of C5/C6 and C6/ C7, and up to 45.3 % of C3/C4 and C4/C5 were larger than the most frequently implanted cervical disc devices. Conclusion Surgeons and manufacturers should be aware of the size mismatch in currently available cervical disc prostheses, which may endanger the safety and efficacy of the procedure. Undersizing the prosthetic device may lead to subsidence, loosening, heterotopic ossification and biomechanical failure caused by an incorrect center of rotation and load distribution, affecting the facet joints.

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Section: Discussionmentioning

confidence: 99%

“…To minimise failures in ACDA, good implant design is required. A wide variety of designs and materials are used, and the ideal shape, position and biomechanics of ACDA have been extensively discussed in the previous reports [6,12,16]. Subsidence and migration is a commonly reported complication in lumbar total disc arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

Footprint mismatch in total cervical disc arthroplasty

et al. 2012

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“…Cervical disc prostheses may be generally characterised as nonconstrained or semiconstrained according to their kinematics. The Bryan disc, a nonconstrained disc, is reportedly associated with segmental kyphotic angulation, probably because of the endplate milling procedures [5,7,10,15,17,18]. On the other hand, the semiconstrained prostheses such as the ProDisc-C may have advantages in restoration of the cervical sagittal alignment but limitations in axial movement and anteroposterior translation [1,2,20].…”

Section: Discussionmentioning

confidence: 99%

Clinical and radiological results of total disc replacement in the cervical spine with preoperative reducible kyphosis

Chen

He²,

Yang

et al. 2012

International Orthopaedics (SICOT)

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Purpose To investigate the clinical and radiological results of total disc replacement (TDR) in the cervical spine with preoperative reducible kyphosis, and discuss when TDR is indicated for the patients with preoperative kyphosis. Methods Fifty-two patients who underwent single-level cervical TDR from June 2008 to May 2010 were included in this study. TDR was indicated for patients with preoperative lordosis or reducible kyphosis, and the patients were divided into a lordotic group (preoperative global angle of ≥0°) and kyphotic group (preoperative global angle of <0°). Clinical results were evaluated using the Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score and Neck Disablity Index (NDI). For radiological evaluation, the global and functional spinal unit (FSU) angles and the global and FSU range of motion were measured preoperatively and postoperatively. Results The mean NDI in the kyphotic group was significantly higher than that in the lordotic group preoperatively and at six months postoperatively, but the groups showed no significant differences in JOA score, VAS score and NDI at the two year follow-up. The mean global and FSU angles in the kyphotic group were significantly lower than those in the lordotic group preoperatively and at six months postoperatively, but they gradually improved postoperatively. The differences lost significance at the two year follow-up.

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“…Some studies reported that sagittal alignment in the cervical spine could be altered after TDR implantation [25][26][27][28]. This adverse effect was particularly noted after implantation of Bryan TM disc [26,28].…”

Section: Sagittal Alignmentmentioning

confidence: 99%

“…This adverse effect was particularly noted after implantation of Bryan TM disc [26,28]. As example, Kim et al [28] found that only 36% of patients with a preoperative lordotic sagittal orientation of the functional spine unit were able to maintain segmental lordosis following surgery (which consisted of implantation of Bryan TM device at one level).…”

Section: Sagittal Alignmentmentioning

confidence: 99%

Sagittal alignment and kinematics at instrumented and adjacent levels after total disc replacement in the cervical spine

et al. 2012

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Background The purpose of the study was to report radiological outcomes after total disc replacement (TDR) in the cervical spine through a 24 months follow-up (FU) prospective study with a special focus on sagittal alignment and kinematics at instrumented and adjacent levels. Materials and methods Thirty-two patients, who sustained one-level TDR with a ball-and-socket arthroplasty (Discocerv TM implant, Scient'x/Alphatec Spine, USA) were consecutively included in the study. Clinical (visual analogical scale and neck disability index) and radiological parameters were measured preoperatively and postoperatively at 3/6 months, 1-year and 2-year FU. Sagittal alignment, ranges of motion (ROM) and center of rotations (CORs) were analyzed using specific motion analysis software (Spineview TM , Paris, France). Patients CORs were compared with those of a control group of 39 normal and asymptomatic subjects.Results Both local and C3-C7 lordosis significantly increased postoperatively (?8°and ?13°at 2 years, respectively). At instrumented level ROM in flexionextension (FE) was measured to 10.2°preoperatively versus 7.5°at 1 year and 6.1°at 2 years. There were no differences in ROM at adjacent levels between pre and postoperative assessments. When compared with control group and preoperative measurements, we noted postoperative cranial shift of the COR at instrumented level for patients group. In contrast, there was no difference in CORs location at adjacent levels. Conclusion Through this prospective study, we observed that cervical lordosis consistently increased after TDR. In addition, although ball-and-socket arthroplasty did not fully restore native segmental kinematics with significant reduction of motion in FE and consistent cranial shift of the COR, no significant changes in terms of ROM and CORs were observed at adjacent levels.

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Design limitations of Bryan disc arthroplasty

Cited by 79 publications

References 13 publications

Footprint mismatch in total cervical disc arthroplasty

Footprint mismatch in total cervical disc arthroplasty

Clinical and radiological results of total disc replacement in the cervical spine with preoperative reducible kyphosis

Sagittal alignment and kinematics at instrumented and adjacent levels after total disc replacement in the cervical spine

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