Clinical and radiological results following cervical arthroplasty

Acta Neurochir (Wien). 2006 Sep;148(9):943-50. doi: 10.1007/s00701-006-0805-6. Epub 2006 Jun 23.


Background: This was a retrospective study of clinical and radiological results of cervical arthroplasty using the Bryan cervical disc prosthesis to evaluate the efficacy of arthroplasty in clinical applications.

Methods: A total of 46 patients underwent arthroplasty of a single level using the Bryan disc prosthesis. Clinical outcome was assessed using the visual analogue scale (VAS) and the neck disability index (NDI). All patients were evaluated using preoperative and postoperative static cervical spine radiographs to compare cervical sagittal balance. Dynamic cervical spine radiographs were used to compare movement at the level of the procedure, movement at the adjacent level and movement of the whole cervical spine.

Findings: With the exception of four patients with aggravated neck pain, the NDI and VAS scores decreased significantly in late follow-up evaluations. The range of movement of the whole cervical spine, the functional segmental unit, and the adjacent segments were preserved after arthroplasty. The sagittal alignment of the cervical spine showed kyphosis after surgery but restored lordosis at a later time. The postulated cause of kyphotic changes include "over-milling" at the dorsal endplate, inappropriate angle of disc insertion, structural absence of lordosis in the Bryan disc, removal of posterior longitudinal ligament, and pre-existing kyphosis.

Conclusions: Arthroplasty using the Bryan disc appears to be safe and provided a favorable preliminary clinical and radiological outcome. Postoperative kyphosis can be prevented by understanding the biomechanical properties of the Bryan disc. Future studies will need to address the association between postoperative kyphosis, clinical outcome and adjacent segment disease.

MeSH terms

  • Adult
  • Arthroplasty / instrumentation
  • Arthroplasty / methods*
  • Biomechanical Phenomena
  • Cervical Vertebrae / diagnostic imaging
  • Cervical Vertebrae / pathology
  • Cervical Vertebrae / surgery*
  • Diskectomy / instrumentation
  • Diskectomy / methods*
  • Female
  • Humans
  • Intervertebral Disc Displacement / diagnostic imaging
  • Intervertebral Disc Displacement / pathology
  • Intervertebral Disc Displacement / surgery*
  • Kyphosis / diagnostic imaging
  • Kyphosis / etiology
  • Kyphosis / pathology
  • Longitudinal Ligaments / injuries
  • Longitudinal Ligaments / physiology
  • Longitudinal Ligaments / surgery
  • Male
  • Middle Aged
  • Neck Pain / etiology
  • Neck Pain / surgery
  • Patient Selection
  • Postoperative Complications / etiology
  • Postoperative Complications / physiopathology
  • Postoperative Complications / prevention & control
  • Prostheses and Implants*
  • Radiography
  • Range of Motion, Articular / physiology
  • Retrospective Studies
  • Spinal Fusion / adverse effects
  • Treatment Outcome