Goffin et al (6) described the use of cervical arthroplasty in an attempt to maintain cervical motion and avoid arthrodesis (fusion) after decompression. In their study, 60 patients underwent single level anterior cervical decompression and placement of an artificial disc prosthesis. Of note is that 93% of Goffin's patients had predominantly radiculopathy. They reported follow-up at 12 months with clinical success reported at between 85 and 90%. No subsidence of the devices was noted and possibly 2 patients had device migration. No spondylotic bridging occurred at the implanted disc space. Range of motion was preserved and no device had been explanted or surgically revised. Sekhon has reported on the use of the Bryan® disc in cervical myelopathy with good results. (11)
The main questions with regard to this procedure relate to longevity of the implant and whether issues such as particle and wear debris will surface as new complications in the future. Between 500 and 1000 implants have been placed worldwide with none removed because of implant failure. A single case of fusion over the implant has been reported (10). The purported protective effect for adjacent levels is not yet known because of the short period of follow up to date and demonstration of the superiority of this technique in terms of reduced adjacent segment disease as compared to arthrodesis (fusion) is still to be shown. Experimentally, the prosthesis has been tested to the equivalent of 47 human years of movement with little wear.
The pitfalls of anterior cervical decompression and fusion have been discussed and the risks of adjacent segment disease have fueled the search for alternative interventions. It is hoped that by combining arthroplasty with anterior cervical decompression the traditionally good outcomes attained by anterior decompressive procedures can be married to the known advantages of maintenance of normal motion.
The Bryan® cervical disc prosthesis is at the forefront of cervical arthroplasty and is available today, allowing for anterior decompression of the spinal cord and nerve roots without the need for plating and fusion, bone grafting or cervical immobilization in a collar. The longevity and long term benefits of cervical arthroplasty remain to be seen.
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