Cervical Artificial Disc Surgery

Patient Experience: Part 3

Peer Reviewed

Typical Surgical Experience for the Patient

Bryan® Artificial DiscThe experience for the patient undergoing implantation of the Bryan® artificial cervical disc is remarkably similar to that for a patient undergoing an anterior cervical decompression and fusion except that no hip graft is required (which itself can have up to a 20% complication rate) and no collar (brace) is required.

Operating time is one-and-a-half to two-hours. I discharge my patients from the hospital within 48-96 hours after surgery with no adverse effects. There are no restrictions on activities after surgery and a return to work can be done as soon as the patient feels up to it.

The effects of smoking may not adversely impact the Bryan® disc implantation as it does on cervical fusions. Regular follow-ups with x-rays are required for several years.

Controversial Areas
The use of the Bryan® cervical disc prosthesis in multi-level disease, deformity, discogenic neck pain, or in the reversal of a previous fusion is not clear. I have used the prosthesis in all these scenarios with good outcomes. However, careful decision-making by the surgeon is required.

Key Points

(1) The selection of patients for this surgery is very particular and left to very specialized spinal surgeons

(2) We do not yet know the long term outcomes of having an artificial disc for 50+ years

(3) Over 500 artificial cervical discs have been placed in patients in Europe over the past 2 years and none have been removed

Prestige® Cervical Disc System
The Prestige® cervical disc system is another type of artificial disc. The Prestige disc is the current manifestation of what was originally termed the "Cummins Disc" or "Bristol Disc". It has been available for more than 10 years.

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It consists entirely of stainless steel or titanium. It is a ball and socket construct. The artificial disc is screwed into place and to date can only be used for single-level disc disease. This implant is less popular than the Bryan® Cervical Disc System and is not available in the United States or Australia. The insertion is less meticulous than the Bryan disc, but the fundamental goals are identical.

Conclusion
The introduction of reliable and safe cervical disc replacement is an exciting time for patients and surgeons in the management of cervical disc disease. Just as hip and knee replacements are commonplace, I would envision that replacement of cervical discs, and possibly even facet joints in th future, will be a commonplace, widely available surgical procedure.

Updated on: 12/22/15
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Artificial Disc Surgery in the Cervical Spine
Richard D. Guyer, MD
Dr. Sekhon has touched upon a very exciting treatment option for neck and arm pain sufferers who do not respond to the usual non-operative treatment some of which includes rest, physical therapy, anti-inflammatory medications, chiropractic (provided there is no spinal cord compression), and injections. Should they have an operatively reparable problem, the gold standard has been the anterior cervical fusion or a posterior decompression for the appropriate pathology. On the other hand, there are newer options that are now being utilized outside of the United States and in the U.S. under the aupices of an FDA IDE (Investigational Device Exemption) Study for the Bryan Cervical Disc Replacement. The advantages of such a device are less stress on adjacent discs, faster rehabilitation and return to regular activities quickly since you don't have to wait for a fusion to occur. Long term studies of at least 2 years (required by the FDA) are needed to determine if indeed these theoretical advantages are better than a traditional fusion. There are many more discs that are being readied for FDA IDE studies in the U.S within the next year. Like total hip replacement, we are seeing the 1st generation devices for there will be many advances in the the future of cervical disc replacement. While the early results are encouraging, the true test comes when the long term follow up data is available.
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Artificial Disc Surgery in the Cervical Spine

Cervical disc replacement is a new technique that is becoming more available worldwide. In Part 1 of his article, Dr. Lali Sekhon discusses cervical discs and fusion.
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