Category: Cervical Disc Replacement

Commentary on an article by Ben J. Garrido, MD, et al.: "Adjacent-Level Cervical Ossification After Bryan Cervical Disc Arthroplasty Compared with Anterior Cervical Discectomy and Fusion": Cervical Disc Replacement Shows Compelling Difference in Adjacent-

Commentary on an article by Ben J. Garrido, MD, et al.: “Adjacent-Level Cervical Ossification After Bryan Cervical Disc Arthroplasty Compared with Anterior Cervical Discectomy and Fusion”: Cervical Disc Replacement Shows Compelling Difference in Adjacent-Level Ossification Development.

J Bone Joint Surg Am. 2011 Jul 6;93(13):e761-1

Authors: Hart RA

PMID: 21776561 [PubMed – in process]

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The intermediate clinical outcome and its limitations of bryan cervical arthroplasty for treatment of cervical disc herniation.

The intermediate clinical outcome and its limitations of bryan cervical arthroplasty for treatment of cervical disc herniation.

J Spinal Disord Tech. 2011 Jun;24(4):221-9

Authors: Ren X, Wang W, Chu T, Wang J, Li C, Jiang T

This is a prospective, consecutive series study to determine the role of the Bryan artificial cervical disc replacement to treat the isolated cervical disc herniation for Chinese patients.

PMID: 20634725 [PubMed – in process]

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Analysis of segmental cervical spine vertebral motion after prodisc-C cervical disc replacement.

Analysis of segmental cervical spine vertebral motion after prodisc-C cervical disc replacement.

Spine (Phila Pa 1976). 2010 Apr 15;35(8):E285-9

Authors: Park JJ, Quirno M, Cunningham MR, Schwarzkopf R, Bendo JA, Spivak JM, Goldstein JA

Retrospective study of patients enrolled in a prospective randomized Food and Drug Administration trial with single level cervical disc replacement (CDR) with the ProDisc-C (Synthes, Paoli, PA).

PMID: 20354472 [PubMed – indexed for MEDLINE]

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Surgical management of cervical degenerative disease: the evidence related to indications, impact, and outcome.

Surgical management of cervical degenerative disease: the evidence related to indications, impact, and outcome.

J Neurosurg Spine. 2009 Aug;11(2):97-100

Authors: Fehlings MG, Arvin B

In this special edition of Journal of Neurosurgery: Spine, a series of systematic reviews sponsored by the Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons/Congress of Neurological Surgeons is presented. This collection of comprehensive reviews summarizes the medical evidence related to the surgical management of cervical degenerative disc disease. Several of the key conclusions are discussed in this introduction to the issue: There is Class II evidence to suggest that the clinical condition remains stable when observed over a 3-year period in patients with mild-to-moderate cervical spondylotic myelopathy (CSM) and age younger than 75 years. There is consistent Class III evidence that the duration of symptoms, and possibly advancing age, negatively affect outcome in patients with CSM. There is Class II evidence that somatosensory evoked potentials have prognostic value in patients with CSM. There is Class I evidence to show that electromyographic abnormalities (as well as the presence of radiculopathy) are predictive of the development of myelopathy in minimally symptomatic patients with cervical stenosis and spinal cord compression. The presence of a low signal on T1-weighted images, high signal on T2-weighted images, and the presence of cord atrophy on preoperative MR images are indicators of a poor outcome in CSM. There is Class III evidence to show that anterior or posterior surgical approaches that effectively decompress the cervical canal promote short-term improvements in outcome. However, there appears to be a risk of late kyphosis in patients who undergo laminectomy or anterior cervical discectomy alone compared with patients in whom decompression is combined with fusion. The use of BMP-2 is discouraged for anterior cervical spine surgery based on evidence suggesting that the risks outweigh any potential benefits. Finally, in patients with symptomatic cervical radiculopathy, arthroplasty achieves outcomes that are equivalent to anterior cervical decompression and fusion, although evidence for superiority is lacking. Further prospective longitudinal data are required to better define the role and timing of surgical intervention in CSM and to determine the appropriate use of cervical arthroplasty in the management of symptomatic cervical degenerative disc disease.

PMID: 19769487 [PubMed – indexed for MEDLINE]

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Cervical radiculopathy: current diagnostic and treatment options.

Cervical radiculopathy: current diagnostic and treatment options.

J Surg Orthop Adv. 2009;18(1):13-8

Authors: Nasca RJ

Cervical nerve root compression, in contrast to nerve root irritation, results in an objective neurologic deficit of the affected nerve root. The purpose of this article is to highlight current diagnostic and treatment options that have proven efficient and safe in managing cervical root compression. The natural history of cervical disc disease and the clinical patterns and causes of cervical radiculopathy are reviewed. Electromyography and reformatted mutiplanar CT scans in addition to MRI are valuable diagnostic modalities. Although anterior cervical discectomy and interbody fusion remains the gold standard of treatment, microendoscopic foraminotomies and discectomies done from posterior and anterior approaches are effective and safe. The role of disc arthroplasty in the treatment of radiculopathy is evolving.

PMID: 19327260 [PubMed – indexed for MEDLINE]

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Prospective, randomized, multicenter study of cervical arthroplasty: 269 patients from the Kineflex|C artificial disc investigational device exemption study with a minimum 2-year follow-up.

Prospective, randomized, multicenter study of cervical arthroplasty: 269 patients from the Kineflex|C artificial disc investigational device exemption study with a minimum 2-year follow-up.

J Neurosurg Spine. 2011 Jun 24;

Authors: Coric D, Nunley PD, Guyer RD, Musante D, Carmody CN, Gordon CR, Lauryssen C, Ohnmeiss DD, Boltes MO

Object Cervical total disc replacement (CTDR) represents a relatively novel procedure intended to address some of the shortcomings associated with anterior cervical discectomy and fusion (ACDF) by preserving motion at the treated level. This prospective, randomized, multicenter study evaluates the safety and efficacy of a new metal-on-metal CTDR implant (Kineflex|C) by comparing it with ACDF in the treatment of single-level spondylosis with radiculopathy. Methods The study was a prospective, randomized US FDA Investigational Device Exemption (IDE) pivotal trial conducted at 21 centers across the US. The primary clinical outcome measures included the Neck Disability Index (NDI), visual analog scale (VAS) scores, and a composite measure of clinical success. Patients were randomized to CTDR using the Kineflex|C (SpinalMotion, Inc.) cervical artificial disc or ACDF using structural allograft and an anterior plate. Results A total of 269 patients were enrolled and randomly assigned to either CTDR (136 patients) or to ACDF (133 patients). There were no significant differences between the CTDR and ACDF groups when comparing operative time, blood loss, length of hospital stay, or the reoperation rate at the index level. The overall success rate was significantly greater in the CTDR group (85%) compared with the ACDF group (71%) (p = 0.05). In both groups, the mean NDI scores improved significantly by 6 weeks after surgery and remained significantly improved throughout the 24-month follow-up (p < 0.0001). Similarly, the VAS pain scores improved significantly by 6 weeks and remained significantly improved through the 24-month follow-up (p < 0.0001). The range of motion (ROM) in the CTDR group decreased at 3 months but was significantly greater than the preoperative mean at 12- and 24-month follow-up. The ROM in the ACDF group was significantly reduced by 3 months and remained so throughout the follow-up. Adjacent-level degeneration was also evaluated in both groups from preoperatively to 2-year follow-up and was classified as none, mild, moderate, or severe. Preoperatively, there were no significant differences between groups when evaluating the different levels of adjacent-level degeneration. At the 2-year follow-up, there were significantly more patients in the ACDF group with severe adjacent-level radiographic changes (p < 0.0001). However, there were no significant differences between groups in adjacent-level reoperation rate (7.6% for the Kineflex|C group and 6.1% for the ACDF group). Conclusions Cervical total disc replacement allows for neural decompression and clinical results comparable to ACDF. Kineflex|C was associated with a significantly greater overall success rate than fusion while maintaining motion at the index level. Furthermore, there were significantly fewer Kineflex|C patients showing severe adjacent-level radiographic changes at the 2-year follow-up. These results from a prospective, randomized study support that Kineflex|C CTDR is a viable alternative to ACDF in select patients with cervical radiculopathy.

PMID: 21699471 [PubMed – as supplied by publisher]

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Application of cervical arthroplasty with Bryan cervical disc: long-term X-ray and magnetic resonance imaging follow-up results.

Application of cervical arthroplasty with Bryan cervical disc: long-term X-ray and magnetic resonance imaging follow-up results.

Chin Med J (Engl). 2010 Nov;123(21):2999-3002

Authors: Zhao YB, Sun Y, Chen ZQ, Liu ZJ

Cervical disc arthroplasty is a new technique for treating degenerative cervical disease. Its goal is to avoid the degeneration of adjacent levels by preserving motion at the treated level. The aims of this study were to evaluate the radiologic outcomes of Bryan cervical disc replacement and the degenerative status of adjacent segments.

PMID: 21162945 [PubMed – indexed for MEDLINE]

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Difference in occurrence of heterotopic ossification according to prosthesis type in the cervical artificial disc replacement.

Difference in occurrence of heterotopic ossification according to prosthesis type in the cervical artificial disc replacement.

Spine (Phila Pa 1976). 2010 Jul 15;35(16):1556-61

Authors: Yi S, Kim KN, Yang MS, Yang JW, Kim H, Ha Y, Yoon do H, Shin HC

Retrospective study of the difference of heterotopic ossification (HO) occurrence according to 3 different types of prosthesis.

PMID: 20581764 [PubMed – indexed for MEDLINE]

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Anterior decompression and fusion versus laminoplasty for cervical myelopathy caused by soft disc herniation: a prospective multicenter study.

Anterior decompression and fusion versus laminoplasty for cervical myelopathy caused by soft disc herniation: a prospective multicenter study.

J Orthop Sci. 2010 Jan;15(1):71-8

Authors: Koakutsu T, Morozumi N, Ishii Y, Kasama F, Sato T, Tanaka Y, Kokubun S, Yamazaki S

Anterior decompression and fusion (ADF) has conventionally been used, with stable outcomes, for cervical myelopathy caused by soft disc herniation. However, complications related to bone grafting and recurrence of myelopathy due to adjacent segment degeneration are its drawbacks. The efficacy of laminoplasty as an alternative has been sporadically reported, but no prospective study has been conducted to verify it. The purpose of this study was to determine whether laminoplasty is comparable for this condition.

PMID: 20151254 [PubMed – indexed for MEDLINE]

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