Comparison of Clinical and Radiographic Changes after Bryan Disc Arthroplasty versus ACDF: A 60-Month Follow-Up on 120 Patients

Background: Artificial cervical disc replacement has become an option for cervical radiculopathy. Previous studies have evaluated the efficacy of this alternative without the scientific rigor of a concurrent control population in oriental patients for long-term follow-up. Objective: Therefore, we asked whether the 1) clinical and 2) radiographic outcomes of Bryan cervical disc prosthesis were better than that of anterior cervical discectomy and fusion (ACDF) at single site, and whether the 3) occurrences of heterotopic ossifications (HOs) were associated to the function loss in the long-term follow-up. Methods:?A total of 120 patients with cervical disc disease were randomly assigned to two groups (Bryan or ACDF), and 60-month follow-up is available for all the 120 patients. Clinical outcomes were assessed using Odom’s criteria, visual analogue pain scale (VAS) and Neck Disability Index (NDI). Radiographs were measured to determine the radiographic outcomes and occurrences of heterotopic ossifications (HOs).?Results: The clinical outcomes are not significantly between the two groups (VAS, P = 0.7253;NDI, P = 0.5528). The radiographic outcome ofBryancervical disc prosthesis is better than that of ACDF group at the index level (P < 0.05). 36 (60%) patients ofBryangroup developed heterotopic ossification. But, there is not a significant association between HOs and the loss of movement at the replacement level. Conclusions: The Bryan artificial disc replacement compares favorably to ACDF for the treatment of patients with 1-level cervical disc disease. And theBryandisc may delay adjacent level degeneration by preserving preoperative kinematics at adjacent levels in oriental patients.

Characterization and evaluation of a femtosecond laser-induced osseointegration and an anti-inflammatory structure generated on a titanium alloy

Cell–material interactions during early osseointegration of the bone–implant interface are critical and involve crosstalk between osteoblasts and osteoclasts.The surface properties of titanium implants also play a critical role in cell–material interactions.In this study,femtosecond laser treatment and sandblasting were used to alter the surface morphology,roughness and wettability of a titanium alloy.Osteoblasts and osteoclasts were then cultured on the resulting titanium alloy disks.Four disk groups were tested:a polished titanium alloy(pTi)control;a hydrophilic micro-dislocation titanium alloy(sandblasted Ti(STi));a hydrophobic nano-mastoid Ti alloy(femtosecond laser-treated Ti(FTi));and a hydrophilic hierarchical hybrid micro-/nanostructured Ti alloy[femtosecond laser-treated and sandblasted Ti(FSTi)].The titanium surface treated by the femtosecond laser and sandblasting showed higher biomineralization activity and lower cytotoxicity in simulated body fluid and lactate dehydrogenase assays.Compared to the control surface,the multifunctional titanium surface induced a better cellular response in terms of proliferation,differentiation,mineralization and collagen secretion.Further investigation of macrophage polarization revealed that increased anti-inflammatory factor secretion and decreased proinflammatory factor secretion occurred in the early response of macrophages.Based on the above results,the synergistic effect of the surface properties produced an excellent cellular response at the bone–implant interface,which was mainly reflected by the promotion of early ossteointegration andmacrophage polarization.