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ABSTRACT: The object of this study is to compare radiographic outcomes of anterior cervical decompression and fusion (ACDF) versus cervical
disc replacement using the Bryan Cervical Disc Prosthesis (Medtronic Sofamor Danek, Memphis, TN) in terms of range of motion
(ROM), Functional spinal unit (FSU), overall sagittal alignment (C2–C7), anterior intervertebral height (AIH), posterior intervertebral
height (PIH) and radiographic changes at the implanted and adjacent levels. The study consisted of 105 patients. A total of
63 Bryan disc were placed in 51 patients. A single level procedure was performed in 39 patients and a two-level procedure
in the other 12. Fifty-four patients underwent ACDF, 26 single level cases and 28 double level cases. The Bryan group had
a mean follow-up 19months (12–38). Mean follow-up for the ACDF group was 20months (12–40months). All patients were evaluated
using static and dynamic cervical spine radiographs as well as MR imaging. All patients underwent anterior cervical discectomy
followed by autogenous bone graft with plate (or implantation of a cage) or the Bryan artificial disc prosthesis. Clinical
evaluation included the visual analogue scale (VAS), and neck disability index (NDI). Radiographic evaluation included static
and dynamic flexion-extension radiographs using the computer software (Infinitt PiviewSTAR 5051) program. ROM, disc space
angle, intervertebral height were measured at the operative site and adjacent levels. FSU and overall sagittal alignment (C2–C7)
were also measured pre-operatively, postoperatively and at final follow-up. Radiological change was analyzed using χ
2 test (95% confidence interval). Other data were analyzed using the mixed model (SAS enterprises guide 4.1 versions). There
was clinical improvement within each group in terms of VAS and NDI scores from pre-op to final follow-up but not significantly
between the two groups for both single (VAS p=0.8371, NDI p=0.2872) and double (VAS p=0.2938, NDI p=0.6753) level surgeries. Overall, ROM and intervertebral height was relatively well maintained during the follow-up in
the Bryan group compared to ACDF. Regardless of the number of levels operated on, significant differences were noted for overall
ROM of the cervical spine (p<0.0001) and all other levels except at the upper adjacent level for single level surgeries (p=0.2872). Statistically significant (p<0.0001 and p=0.0172) differences in the trend of intervertebral height measurements between the two groups were noted at all levels
except for the AIH of single level surgeries at the upper (p=0.1264) and lower (p=0.7598) adjacent levels as well as PIH for double level surgeries at the upper (p=0.8363) adjacent level. Radiological change was 3.5times more observed for the ACDF group. Clinical status of both groups,
regardless of the number of levels, showed improvement. Although clinical outcomes between the two groups were not significantly
different at final follow-up, radiographic parameters, namely ROM and intervertebral heights at the operated site, some adjacent
levels as well as FSU and overall sagittal alignment of the cervical spine were relatively well maintained in Bryan group
compared to ACDF group. We surmise that to a certain degree, the maintenance of these parameters could contribute to reduce
development of adjacent level change. Noteworthy is that radiographic change was 3.5times more observed for ACDF surgeries.
A longer period of evaluation is needed, to see if all these radiographic changes will translate to symptomatic adjacent level
disease.
European Spine Journal 04/2012; 18(2):218-231. · 1.97 Impact Factor
