Artikel
Intervertebral disc replacement for cervical degenerative disease – clinical results and functional outcome at two years in patients implanted with the Bryan cervical disc prosthesis
Bandscheibenersatz bei zervikalen degenerativen Erkrankungen – klinische Ergebnisse und funktionelles Oucome nach 2 Jahren bei Patienten mit implantierten zervikalen Bryan-Bandscheibenprothesen
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Autoren
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V. Heidecke
- Department of Neurosurgery, Klinikum Augsburg, Augsburg, Germany
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W. Burkert
- Department of Neurosurgery, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
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M. Brucke
- Department of Neurosurgery, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
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N. G. Rainov
- Department of Neurosurgery, Klinikum Augsburg, Augsburg, Germany
| Veröffentlicht: | 30. Mai 2008 |
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Gliederung
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Objective: This is a prospective study of patients with degenerative cervical disease who underwent ventral discectomy and disc replacement with the Bryan cervical disc prosthesis. The objective was to investigate two-year clinical outcome of patients implanted with the Bryan disc and to evaluate function of the implant itself.
Methods: Fifty-four consecutive cases with cervical disc herniation and/or spondylosis with preserved mobility in the affected spinal segments were enrolled. Patients presented clinically with cervical radiculopathy and/or myelopathy with or without neck pain. A standard anterior cervical discectomy was carried out and a Bryan disc was implanted in the affected levels. A total of 59 prosthetic discs were implanted, in 49 cases at a single level and in 5 cases at two adjacent levels. The neurological status was evaluated at baseline and at one and two years thereafter. Plain X-rays, CT, and MRI were used for preoperative diagnostics. Postoperative follow-up was done by X-rays.
Results: All patients had an excellent or good long-term neurological outcome according to the Odom criteria. Loss of function (motion range <3°) was found in 7 out of 59 Bryan discs at two years after surgery (12%). Heterotopic ossification (HO) of the McAffee grades 1 to 4 was seen in a total of 17 segments (29%). There were no implant dislocations or migrations.
Conclusions: Implantation of the Bryan disc resulted in excellent or good clinical and neurological outcome in all cases. The surgical technique was safe and without complications. Twelve percent of the implanted Bryan discs lost mobility at two years, mainly due to HO. A trend was seen towards development of HO in the operated segments. Therefore, the functional outcome of the implant in this study was inferior to the clinical outcome. Further investigations with longer follow-up periods and with a control group (e.g. fusion with intervertebral cage) will be necessary for a definitive assessment of the long-term functionality and benefits of artificial cervical discs.
