The criteria for selection for placement of the Bryan® disc prosthesis are more strict than that for anterior cervical fusion surgery. Patients with hypermobility (excessive motion), instability, gross degenerative disease, primarily facet joint pathology, and severe osteoporosis are excluded. The precise role in discogenic neck pain is unclear. Typically C4-5 and C5-6 are instrumented but C3-4 may be done if there is adequate access and C6-7 can be performed if it is able to be visualized on lateral fluoroscopy.
The case is performed with fluouroscopic guidance throughout for real time feedback (see Figure 3).
Figure 3: Typical set up for Bryan cervical arthroplasty.
The patient is postioned supine with slight neck extension.
The fluoroscope is draped in and used for the entire case.
The apparatus for milling and placement of the Bryan® disc allows for precise centering of the prosthesis into the center of the disc space with a precise angle calculated before the skin incision is made (see Figure 4).
Figure 4: The apparatus used for milling and prosthesis placement is
technically more refined and exacting than that used for anterior cervical fusion surgery.
Once the prosthesis is placed, no collar is required and the prosthesis sits with a low profile in the pre-vertebral space (see Figure 5).
Figure 5: Surgeon's eye view of the final
placement of the implant prior to wound closure.
A typical case is shown in Figure 6.
Figure 6: A typical case of myelopathy secondary to central C5-6 disc protusion (top). The postoperative AP, lateral, flexion and extension x-rays are shown in the bottom row confirming total disc arthroplasty with preservation of normal motion.