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Sagittal alignment after Bryan cervical arthroplasty.

Rick C Sasso1, Newton H Metcalf, John A Hipp

  • 1Indiana Spine Group, Indiana University School of Medicine, Indianapolis 46260, USA. rsasso@indianaspinegroup.com

Spine
|March 2, 2011
PubMed
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The Bryan cervical disc showed a minor, insignificant increase in lordosis post-surgery. Cervical sagittal alignment and lordosis remained equivalent between Bryan disc arthroplasty and fusion patients at 2 years.

Area of Science:

  • Spine surgery
  • Cervical arthroplasty
  • Radiographic analysis

Background:

  • Previous studies suggest Bryan arthroplasty offers better functional outcomes than anterior cervical discectomy and fusion.
  • Concerns exist regarding kyphosis after cervical disc replacement, but prospective data on sagittal alignment is limited.
  • This study addresses the need for critical assessment of sagittal alignment following cervical arthroplasty.

Purpose of the Study:

  • To evaluate the radiographic sagittal alignment of the Bryan cervical disc in patients with one-level cervical disease.
  • To compare cervical sagittal alignment and range of motion between Bryan disc arthroplasty and anterior cervical discectomy and fusion.
  • To determine if Bryan disc arthroplasty leads to clinically significant segmental kyphosis.

Main Methods:

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  • Prospective, randomized, Food and Drug Administration Investigational Device Exemption trial.
  • Forty-eight patients with a minimum 2-year follow-up.
  • Quantitative motion analysis assessed overall and treatment-level sagittal alignment, disc heights, and range of motion (ROM).

Main Results:

  • No statistically significant difference in overall cervical lordosis between Bryan disc and fusion groups at 24 months.
  • Bryan disc group showed a nonsignificant 0.92° increase in lordosis at the treated level immediately post-op.
  • Posterior disc height was slightly greater in the Bryan group (0.7 mm, P=0.04); ROM was equivalent in the Bryan group but decreased significantly after fusion.

Conclusions:

  • Bryan disc arthroplasty did not result in a clinically significant increase in segmental kyphosis.
  • Overall cervical sagittal alignment and global lordosis were statistically equivalent between the Bryan disc and fusion groups at 2-year follow-up.
  • The study provides prospective evidence supporting the maintenance of sagittal alignment with Bryan disc arthroplasty.