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Segmental malalignment with the Bryan Cervical Disc prosthesis--does it occur?

William R Sears1, Lali H Sekhon, Neil Duggal

  • 1Department of Neurosurgery, Sydney NeuroSpine Clinic and Royal North Shore and Dalcross Private Hospitals, Sydney, Australia. thesears@bigpond.com

Journal of Spinal Disorders & Techniques
|February 8, 2007
PubMed
Summary
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The Bryan Cervical Disc prosthesis may cause a slight loss in functional spinal unit lordosis and cervical alignment post-surgery. Variations in sagittal deformity were noted among patients and surgeons.

Area of Science:

  • Spine surgery
  • Orthopedic biomechanics
  • Radiographic analysis

Background:

  • Early clinical outcomes of the Bryan Cervical Disc prosthesis are promising.
  • However, recent studies indicate potential postoperative kyphosis in the functional spinal unit (FSU).

Purpose of the Study:

  • To precisely evaluate sagittal deformity after Bryan Cervical Disc prosthesis implantation.
  • To assess FSU sagittal angulation, prosthesis shell angulation, segmental olisthesis, and cervical alignment in a large, multi-surgeon case series.

Main Methods:

  • Analysis of neutral, erect X-rays from 67 patients (88 disc levels) using manual and digital imaging techniques.
  • Measurements included FSU sagittal angulation, prosthesis shell angulation, segmental olisthesis, and overall cervical alignment.

Related Experiment Videos

  • Interobserver and intraobserver studies confirmed measurement accuracy.

    • Main Results:

    • A median loss of 2 degrees in FSU lordosis was observed post-surgery (P<0.0001).
    • Median prosthesis shell kyphosis was 2 degrees, with weak correlation to FSU lordosis changes.
    • Significant differences in FSU lordosis loss were found between surgeons (P=0.005).
    • Median olisthesis was -0.1 mm, and overall cervical lordosis reduced by a median of 4 degrees (P<0.004).

    Conclusions:

    • Insertion of the Bryan disc prosthesis results in a small, median loss of FSU lordosis.
    • Observed sagittal alignment changes are generally minor but show variability among patients and surgeons.
    • Further investigation is warranted to identify factors influencing postoperative sagittal alignment.