Motion Analysis of Bryan Cervical Disc Arthroplasty Versus Anterior Discectomy and Fusion: Results From a Prospective, Randomized, Multicenter, Clinical Trial

Sasso, Rick C.; Best, Natalie M.; Metcalf, Newton; Anderson, Paul A.

doi:10.1097/bsd.0b013e318150d121

Cited by 87 publications

(52 citation statements)

References 21 publications

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“…Most authors [1-10, 12, 19] observed the effect of general motion preservation at the implanted level regardless of the specific prosthesis design. In those studies, some groups have shown an increased motion [1][2][3][4], whereas others have shown no change [5][6][7] or decreased motion [8][9][10]. In contrast to Du et al [4], CDR with the Discover disc was able to maintain a mean of 8.4 ± 6.3°of FSU ROM at the 2-year follow-up in our group, which was significantly less than the preoperative ROM (P = 0.008).…”

Section: Discussioncontrasting

confidence: 52%

“…Currently, there are many commercially available artificial discs with different biomechanical properties. Some prostheses have shown increased ROM postoperatively [1][2][3][4], while others have shown no change [5][6][7] or decreased ROM [8][9][10]. Interestingly, some prostheses have been shown to aid in restoration of cervical lordosis postoperatively [11][12][13][14], while others have shown no change [2,4] or trend toward kyphosis [5,15,16].…”

Section: Introductionmentioning

confidence: 99%

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Cervical arthroplasty with Discover prosthesis: clinical outcomes and analysis of factors that may influence postoperative range of motion

Liang

et al. 2013

Eur Spine J

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Purpose The aim of this current study was to analyze the clinical outcomes after Discover cervical disc replacement and its effects on maintaining cervical lordosis and range of motion (ROM). The possible factors influencing postoperative ROM were analyzed. Method 27 men and 28 women with a mean age of 46.4 ± 8.7 years were prospectively followed up for 2 years. Clinical outcomes were assessed using Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), visual analog scale (VAS) and Odom's criteria. Radiographic information including segment and overall alignment, functional spinal unit (FSU) and overall ROM, and disc heights were prospectively collected during the follow-up. The correlations between the postoperative FSU ROM at last follow-up and influencing factors were analyzed. Results Mean NDI, JOA and VAS scores showed statistical improvements at last follow-up. Anterior migration of the prosthesis was detected in six cases. Heterotopic ossification was observed in ten patients. Mean FSU angle, endplate angle of the treated level and mean overall cervical alignment were all improved significantly at last follow-up (P \ 0.001). However, mean FSU ROM of the treated segment significantly decreased postoperatively (P = 0.008), while mean overall ROM showed no significant differences. A significant correlation was found between preoperative FSU ROM and postoperative FSU ROM by the Pearson correlation coefficient (r = 0.325, P = 0.034). Multiple linear regression analysis confirmed that preoperative FSU ROM contributed independently to a model with a coefficient of determination of 0.37 (P = 0.034). Conclusions In the 2 years follow-up, the Discover cervical disc arthroplasty has provided satisfactory clinical outcomes. It was able to substantially restore segment and overall cervical alignment while partially maintaining segment and overall cervical ROM. Additionally, we found that postoperative FSU ROM positively correlated with preoperative FSU ROM.

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Section: Discussioncontrasting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Cervical arthroplasty with Discover prosthesis: clinical outcomes and analysis of factors that may influence postoperative range of motion

Liang

et al. 2013

Eur Spine J

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“…In fact, just four separate research groups have carried out sizeable RCTs of cervical disc arthroplasty vs fusion, although their results have been presented in multiple publications addressing different subtopics within the same trials or by individual groups of authors participating in the multicentre studies [3,25,29,37,38,[44][45][46]. Collectively, these and one other small RCT [42] have shown statistically superior or comparable results for arthroplasty in relation to patient-rated outcomes such as the Neck Disability Index (NDI), neck and arm pain and quality of life (SF36).…”

Section: Introductionmentioning

confidence: 99%

“…Collectively, these and one other small RCT [42] have shown statistically superior or comparable results for arthroplasty in relation to patient-rated outcomes such as the Neck Disability Index (NDI), neck and arm pain and quality of life (SF36). The maintenance of segmental mobility with disc arthroplasty, expected to contribute to a reduced development of adjacent level change, has also been documented in three trials [29,38,44]. Although these studies possess the acknowledged scientific rigour of RCTs, they are not without their limitations.…”

Section: Introductionmentioning

confidence: 99%

A comparison of outcomes of cervical disc arthroplasty and fusion in everyday clinical practice: surgical and methodological aspects

et al. 2009

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Randomised controlled trials (RCTs) of cervical disc arthroplasty vs fusion generally show slightly more favourable results for arthroplasty. However, RCTs in surgery often have limited external validity, since they involve a select group of patients who fit very rigid admission criteria and who are prepared to subject themselves to randomisation. The aim of this study was to examine whether the findings of RCTs are verified by observational data recorded in our Spine Center in association with the Spine Society of Europe Spine Tango surgical registry. Patients undergoing fusion/stabilisation or disc arthroplasty for degenerative cervical spinal disease were selected for inclusion. They completed a questionnaire pre-operatively and at 12 and 24 months follow-up (FU). The questionnaire comprised the multidimensional Core Outcome Measures Index (COMI; 0-10 scale) and, at FU, questions on global outcome and satisfaction with treatment (5-point scales, dichotomised to ''good'' and ''poor''), re-operation and patient-rated complications. The surgeon completed a Spine Tango Surgery form. The outcome data from 266 (208 fusion, 58 arthroplasty) out of 284 eligible patients who had reached 12 months FU, and 169 (139 fusion, 30 arthroplasty) out of 178 who had reached 24 months FU, were included. Patients with cervical disc arthroplasty were younger [46 (SD 8) years vs 56 (SD 11) years for fusion; P \ 0.05], had less comorbidity (P \ 0.05), more often had only mono-segmental pathology (69% arthroplasty, 47% fusion) and only one type of degenerative pathology (69% arthroplasty, 46% fusion). Surgical complication rates were similar in each group (arthroplasty, 1.5%; fusion, 2.6%). The reduction in the COMI score was significantly greater in the arthroplasty group (at 12 months, 4.8 (SD 3.0) vs 3.7 (SD 2.9) points for fusion, and at 24 months 5.1 (SD 2.8) vs 3.8 (SD 2.9) points; each P \ 0.05). In the arthroplasty group, a ''good'' global outcome was recorded in 90% patients (at 12 months) and 93% (at 24 months); in the fusion group the figures were 80 and 82%, respectively (group differences at each timepoint, P [ 0.09). Satisfaction with treatment was similar in both groups (89-93%), at each timepoint. In multiple regression analysis, treatment group was of borderline significance as a unique predictor of the change in COMI at FU (P = 0.059 at 12 months, P = 0.055 at 24 months) in a model in which known confounders (age, comorbidity, number of affected levels) were controlled for. Being in the arthroplasty group was associated with an approximately 1-point greater reduction in the COMI score at FU. The results of this observational study appear to support those of the RCTs and suggest that, in patients with degenerative pathology of the cervical spine, disc arthroplasty is associated with a slightly better outcome than fusion. However, given the small size of the difference, its clinical relevance is questionable, especially in view of the a priori more favourable outcome expected in the arthroplasty group due to ...

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“…In vivo kinematic studies using flexion/extension plain radiograms have also addressed the effects of anterior cervical fusion on the kinematics at the adjacent levels to fusion [4,8,[15][16][17][18][19][20][21][22]. Results of these studies were also variable.…”

Section: Introductionmentioning

confidence: 99%

Three-dimensional kinematic analysis of the cervical spine after anterior cervical decompression and fusion at an adjacent level: a preliminary report

et al. 2011

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Purpose Development of adjacent segment degeneration following anterior cervical decompression and fusion (ACDF) is still controversial, as adjacent-level kinematics is poorly understood. This study reports preliminary data from a high-accuracy 3D analysis technique developed for in vivo cervical kinematics. Methods From nine cervical spondylosis patients, four underwent single-level ACDF, and five underwent two-level ACDF using cylindrical titanium cage implant(s). Pre-and post-surgical CT scans were taken in flexion, neutral and extended positions, allowing us to compute segmental ranges of motion for rotation and translation, and 3D disc-height distributions. Differences in segmental motions and disc-height between fused and adjacent levels were analyzed with a Wilcoxon signed-rank test. Results are presented as mean ± SEM. Results The flexion/extension angular-ROM at the fusion level decreased after surgery (7.46 ± 1.17°vs. 3.14 ± 0.56°, p \ 0.003). The flexion/extension angular-ROM at one caudal adjacent level to the fusion level (3.97 ± 1.29°) tended to be greater post-operatively (6.11 ± 1.44°, p = 0.074). Translation in the anterior-posterior direction during flexion/ extension at the fusion level decreased after surgery (1.22 ± 0.20 mm vs. 0.32 ± 0.11 mm, p \ 0.01). No differences were found in adjacent-level disc heights between both study time-points. Conclusions This study showed increased segmental motion in flexion/extension angular-ROM at one level adjacent to ACDF. However, increases in the rotational angular-ROM were not statistically significant when cranial/caudal adjacent levels were analyzed separately. This preliminary study highlighted the capabilities of a 3D-kinematic analysis method to detect subtle changes in kinematics and disc height at the adjacent levels to ACDF. Thus, reliable evidence related to ACDF's influence on adjacent-level cervical kinematics can be collected.

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Motion Analysis of Bryan Cervical Disc Arthroplasty Versus Anterior Discectomy and Fusion: Results From a Prospective, Randomized, Multicenter, Clinical Trial

Abstract: The Bryan disc treatment, on average, maintained flexion/extension range of motion without degradation over 24 months. No ectopic bridging ossification was seen in any of the Bryan discs and no subsidence or displacement of the Bryan disc occurred.

Cited by 87 publications

References 21 publications

Cervical arthroplasty with Discover prosthesis: clinical outcomes and analysis of factors that may influence postoperative range of motion

Cervical arthroplasty with Discover prosthesis: clinical outcomes and analysis of factors that may influence postoperative range of motion

A comparison of outcomes of cervical disc arthroplasty and fusion in everyday clinical practice: surgical and methodological aspects

Three-dimensional kinematic analysis of the cervical spine after anterior cervical decompression and fusion at an adjacent level: a preliminary report

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