Clinical and radiological outcomes of dynamic cervical implant arthroplasty:A 5-year follow-up

BACKGROUND Dynamic cervical implant(DCI)stabilization has been reported to have satisfactory clinical and radiological results with short-and mid-term follow-up in the treatment of cervical degenerative disc disease.However,few reports about the clinical and radiological outcome with more than 5-year follow-up exist.AIM To investigate the long-term clinical and radiological results of DCI arthroplasty.METHODS A total of 40 patients who received DCI arthroplasty were consecutively reviewed from May 2010 to August 2015.Visual analogue scale(VAS),neck disability index(NDI)score,Japanese Orthopaedic Association(JOA)score,and SF-36 items were used to assess neural function rehabilitation.Static and dynamic radiographs and 3-dimentional computed tomography were used to evaluate the radiological outcomes.RESULTS The scores of neck/arm VAS,NDI,JOA,and 8-dimensions of SF-36 were significantly improved at the 1-mo follow-up(P<0.05)and maintained until the last follow-up(P<0.05).The range of motion(ROM)of C2-C7,functional spinal unit(FSU),upper/lower adjacent level,C2-C7 lateral bending,and FSU lateral bending decreased at the 1-mo follow-up(P<0.05),whereas they increased to the preoperative level at the later follow-up intervals(P>0.05),except the ROM of FSU lateral bending(P<0.05).The C2-C7 alignment and FSU angle kept more lordotic at the last follow-up(P<0.05).The intervertebral height increased significantly at the 1-mo follow-up(P<0.05)and decreased at later follow-ups(P>0.05).At the last follow-up,12(26.1%)segments developed heterotopic ossification.CONCLUSION DCI arthroplasty is a safe and effective non-fusion technique to treat cervical degenerative disc disease in long-term follow-up.

Comparison of adjacent segment degeneration five years after single level cervical fusion and cervical arthroplasty： a retrospective controlled study

Background Cervical arthroplasty is indicated to preserve cervical motion and prevent accelerated adjacent segment degeneration. Whether accelerated adjacent segment degeneration is prevented in the long term is unclear. This trial compared adjacent segment degeneration in Bryan disc arthroplasty with that in anterior cervical decompression and fusion five years after the surgery. Methods We studied patients with single level degenerative cervical disc disease. The extent of adjacent segment degeneration was estimated from lateral X-rays. Results Twenty-six patients underwent single level Bryan disc arthroplasty and twenty-four patients underwent single level anterior cervical decompression and fusion. All patients were followed up for an average of sixty months. In the Bryan arthroplasty group, nine （17.6%） segments developed adjacent segment degeneration, which was significantly lower than that （60.4%） in the anterior cervical decompression and fusion group. Eleven segments in the Bryan arthroplasty group developed heterotopic ossification according to McAfee＇s classification and two segments had range of motion less than 2%. In the heterotopic ossification group, four （19.5%） segments developed adjacent segment degeneration, similar to the number in the non-heterotopic ossification group （16.7%）. Adjacent segment degeneration rate was 50% in grade IV group but 11.8% in grade II to III. Conclusions Adjacent segment degeneration was accelerated after anterior cervical decompression and fusion. However, Bryan disc arthroplasty avoided accelerated adjacent segment degeneration by preserving motion. Patients with grade IV heterotopic ossification lost motion, and the rate of adjacent segment degeneration was higher than that in patients without heterotopic ossification.

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

Background 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.Methods Twenty-two patients at a single center underwent discectomy and implantation of Bryan cervical disc. The mean follow-up period was 60 months （57-69 months）. Twenty patients underwent single-level arthroplasty and two underwent arthroplasty at two levels. The levels of surgery included C3/4 （3 levels）, C4/5 （2 levels）, C5/6 （18 levels） and C6/7 （1 level）. Radiographic evaluation included dynamic X-ray examination and magnetic resonance imaging （MRI） at baseline and at final follow-up.Results On X-ray examination, the range of motion （ROM） at the operated level was 7.2° （2.5°-13.0°） at baseline and 7.8° （1.0°-15.0°） at final follow-up （P 〉0.05）. Heterotopic ossification around the prosthesis was observed in eight levels,and two levels showed loss of motion （ROM 〈2°）. MRI showed worsening by a grade at the upper level in 2/22 patients,and worsening by a grade at the lower level in 3/22, according to Miyazaki＇s classification. No further impingement of the ligamentum flavum into the spinal canal was observed at adjacent levels, though the disc bulge was slightly increased at both the adjacent upper and lower levels at final follow-up.Conclusions Arthroplasty using Bryan cervical disc prosthesis resulted in favorable radiologic outcomes in this study.Disc degeneration at adjacent levels may be postponed by this technique.

Mid-term outcomes of Bryan cervical disc arthroplasty versus anterior cervical discectomy and fusion for cervical spondylopathy

Objective To compare the clinical outcomes of Bryan disc replacement with anterior cervical discectomy and fusion (ACDF) in patients with cervical spondylopathy. Methods Sixteen patients underwent Bryan cervicaldisc replacement (A group) ,and

Clinical and radiographic results of cervical artificial disc arthroplasty： over three years follow-up cohort study

Background Theoretic advantages of cervical disc arthroplasty include preservation of normal motion and biomechanics in the cervical spine, and reduction of adjacent-segment degeneration. The clinical and radiographic effects of cervical disc arthroplasty in short term have been ascertained. The aim of this study is to research the data of mid-term results.Methods In this prospective cohort study, 50 patients who underwent cervical disc arthroplasty from December 2003 to January 2006 were enrolled. There were 39 patients who received 1-level disc arthroplasty, and 11 patients received 2-level disc arthroplasty, with an average age of 50.9 years （range from 29 to 73）. The median follow-up was 41.85months （range from 36.00-55.63 months）. Patients were followed prospectively with respect to their symptoms,neurologic signs, and radiographic results.Results The median value of Japanese Orthopaedic Association （JOA） score was 14.0 before surgery, and 16.5 at the most recent follow-up （P 〈0.01）. The median value of the recovery rate of the JOA score was 92.2%. The preoperative range of motion （ROM） at the indexed level was （10.40±4.97）°, which has significantly correlated with the most recent follow-up ROM which was （8.56±4.76）° （P 〈0.05, r=0.33）. The ROM at the operative level at the most recent follow-upwas greater than the value at the 3-month follow-up of （7.52±3.37）° （P 〈0.05）. The preoperative functional spinal unit （FSU） angulation was （-0.96±6.52）°, which was not significantly correlated with that of the most recent follow-up value of （-2.65±7.95）° （P 〈0.01, r=0.53）. The preoperative endplate angulation was （2.61±4.85）°, which had no significant correlation with that of the most recent follow-up value of （0.71±6.41）° （p 〉0.05）.Conclusions The clinical and radiographic results of cervical disc arthroplasty are good in mid-term follow-up. The normal range of motion of the operated level and the biomechanics in the cervical spine are well preserved.

Cervical Disc Arthroplasty Combined with Interbody Fusion for the Treatment of Cervical Myelopathy with Diffuse Idiopathic Skeletal Hyperostosis： A Case Report

Diftuse idiopathic skeletal hyperostosis （DISHL also known as Forestier＇s disease, was originally reported by Forestier and Rotes-Querol in 1950. It is a common but underdiagnosed skeletal disease characterized by massive ossification of the anterior longitudinal ligament of several vertebral bodies. The most common symptom of cervical DISH is dysphagia due to mechanical compression of the esophagus. Reports of cervical myelopathy associated with DISH are rare. Here, we present a case describing a DISH patient with cervical myelopathy who was effectively treated by a carefully designed surgical procedure.

Cervical disc arthroplasty with ProDisc-C artificial disc： 5-year radiographic follow-up results

Background Cervical disc arthroplasty is an alternative surgery to standard cervical decompression and fusion for disc degeneration. Different types of cervical disc prosthesis are used in China. The aim of this study was to evaluate the radiographic outcomes of cervical arthroplasty using the ProDisc-C prosthesis.

Removal versus preservation of the posterior longitudinal ligament in Bryan cervical disc arthroplasty

Background Bryan cervical disc arthroplasty can be used to restore and maintain the mobility and function of the involved cervical spinal segments. The efficiency of posterior longitudinal ligament （PLL） resection in anterior cervical decompression and fusion has been demonstrated. However, no clinical reports have compared PLL removal with preservation in Bryan cervical disc arthroplasty. This study aimed to assess the role of removal of PLL in Bryan cervical disc arthroplasty at an 18-month follow-up.