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Artificial Disc Insertion Following Anterior Cervical Discectomy

Published online by Cambridge University Press:  02 December 2014

Gwynedd E. Pickett  and
Neil Duggal
Gwynedd E. Pickett
Affiliation:
Division of Neurosurgery, London Health Sciences Centre, London, Ontario, Canada
Neil Duggal
Affiliation:
Division of Neurosurgery, London Health Sciences Centre, London, Ontario, Canada
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Abstract

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Objective and importance:

Fusion following anterior cervical discectomy has been implicated in the acceleration of degenerative changes in the adjacent spinal segments. Discectomy followed by implantation of an artificial cervical disc maintains the functionality of the spinal unit, while still providing excellent symptomatic relief. We describe our preliminary experience with implantation of the Bryan Cervical Disc System in two cases of single-level cervical disc herniation.

Clinical presentation:

Two male patients presented with a left C6 radiculopathy, without evidence of myelopathy. Magnetic resonance imaging revealed a disc herniation at C5-6 in both cases. Pre-operative flexion and extension radiographs demonstrated preserved motion at the involved levels.

Intervention/technique:

Following a standard anterior cervical decompression, precision drilling of the vertebral endplates was carried out using a drill attached to a bed-mounted, gravitationally-referenced retraction frame. An artificial cervical disc, composed of a polyurethane nucleus with titanium endplates, was fitted between the contoured endplates without fixation to the vertebral bodies. No complications were experienced during the insertion of the prosthesis, or in the postoperative course. Both patients experienced immediate postoperative resolution of their radicular pain and were discharged from hospital the following day. At nine months following surgery, both patients continue to have complete relief of radicular symptoms. Postoperative radiographs at six months following surgery confirm accurate placement of the prosthesis and preserved mobility of the functional spinal unit.

Conclusion:

Insertion of the Bryan artificial cervical disc prosthesis following anterior cervical discectomy is a relatively straightforward procedure, which appears to be safe and provides good clinical results, without requiring additional surgical time. Long-term follow-up is required to assess its safety, efficacy, and ability to prevent adjacent segment degeneration.

Résumé:

RÉSUMÉ: Objectif et importance:

Il semble qu’une fusion vertébrale suite à une discectomie cervicale antérieure puisse accélérer les changements dégénératifs au niveau des segments spinaux adjacents. La discectomie suivie de l’implantation d’un disque artificiel maintient la fonction du segment spinal tout en assurant un excellent soulagement des symptômes. Nous décrivons notre expérience d’implantation du Bryan Cervical Disc System chez deux cas de hernie discale cervicale.

Étude de cas:

Il s’agit de deux patients présentant une radiculopathie C6 gauche sans manifestation de myélopathie. L’imagerie par résonance magnétique a montré une hernie discale au niveau de C5-C6 dans les deux cas. Des radiographies prises en flexion et en extension avant la chirurgie ont montré une amplitude de mouvement normale à ces niveaux.

Technique opératoire:

Après décompression cervicale antérieure par la technique standard, les plateaux vertébraux ont été préparés au moyen d’une aléseuse. Un disque cervical artificiel composé d’un noyau de polyuréthane avec des plateaux en titanium a été inséré entre les plateaux vertébraux profilés sans être fixé aux corps vertébraux, sans complication intra ou postopératoire. La douleur radiculaire est disparu immédiatement après la chirurgie et ils ont quitté l’hôpital le lendemain de la chirurgie. Neuf mois plus tard, aucun des deux patients n’a présenté de récidive de la douleur radiculaire. Des radiographies faites six mois après la chirurgie ont confirmé que la prothèse était en bonne position et que la mobilité de l’aunité spinale fonctionnelle était préservée.

Conclusions:

L’insertion d’une prothèse de Bryan après une discectomie cervicale antérieure est une intervention relativement simple qui semble sûre et dont les résultats cliniques sont bons, sans toutefois prolonger l’intervention. Ces patients devront être suivis à long terme afin d’évaluer la sécurité, l’efficacité et l’influence de cette intervention sur la dégénérescence des segments adjacents.

Type
Case Report
Information
Canadian Journal of Neurological Sciences , Volume 30 , Issue 3 , August 2003 , pp. 278 - 283
Copyright
Copyright © The Canadian Journal of Neurological 2003

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