Friedrich Weber1, Michael Detzner. 1. Neurochirurgische Klinik, Kliniken der Stadt Köln gGmbH, Köln, Germany. weberf@kliniken-koeln.de
Abstract
OBJECTIVE: Treatment of radicular or myelopathic symptoms of the vertebral segments from C2 through Th1. INDICATIONS: Discogenic and/or spondylotic radiculopathy. Acute myelopathy. Acute or progressive functional neurological deficit. Persistent pain resistant toward conservative treatment for > 6 weeks. CONTRAINDICATIONS: Chronic myelopathy. Spondylotic myelopathy. Infection. Tumor in the vertebral segment. Ossification of the posterior longitudinal ligament (OPLL). Metabolic bone disease. Osteoporosis. Long-lasting steroid medication. Allergy to titanium, polyurethane and ethylene oxide. Bekhterev's disease. Bony segmental fusion. Instability. SURGICAL TECHNIQUE: Using the Bryan Cervical Disc Template Set together with magnetic resonance or computer tomographic images, the exact size of the prosthesis will be selected. The patient is lying in a supine position and the level of surgery is verified fluoroscopically. Diskectomy and decompression are performed via an anterior approach. After preparation of the implant bed, the center of the disk space is established using a transverse centering tool and inserting the Bryan cervical distractor. Before the prosthesis can be inserted, the end plates have to be milled. The prosthesis is filled with sterile saline solution and inserted. Proper fitting is verified fluoroscopically. POSTOPERATIVE MANAGEMENT: Depending on the clinical situation postoperatively, the patient is discharged. Wound clamps are distracted on day 8, support by a cervical collar is not necessary. Light physical manipulations for muscle relaxation can be performed. RESULTS: Since 2002, 178 patients have received at least one Bryan Cervical Disc Prosthesis. 92 patients had a complete follow- up. Examinations were performed 8 and 12 weeks, respectively, as well as 6 up to 44 months postoperatively. 29 patients received a hybrid implantation. Cobb's angle and range of motion were determined radiologically, the degree of heterotopic ossification was classified according to McAfee. Disk prosthesis placement was measured in relation to the dorsal edge of the vertebral body, the center of the spine, as well as the body axes. For clinical evaluation, the Oswestry Neck Disability Index was used, and the neurostatus was determined.
OBJECTIVE: Treatment of radicular or myelopathic symptoms of the vertebral segments from C2 through Th1. INDICATIONS: Discogenic and/or spondylotic radiculopathy. Acute myelopathy. Acute or progressive functional neurological deficit. Persistent pain resistant toward conservative treatment for > 6 weeks. CONTRAINDICATIONS: Chronic myelopathy. Spondylotic myelopathy. Infection. Tumor in the vertebral segment. Ossification of the posterior longitudinal ligament (OPLL). Metabolic bone disease. Osteoporosis. Long-lasting steroid medication. Allergy to titanium, polyurethane and ethylene oxide. Bekhterev's disease. Bony segmental fusion. Instability. SURGICAL TECHNIQUE: Using the Bryan Cervical Disc Template Set together with magnetic resonance or computer tomographic images, the exact size of the prosthesis will be selected. The patient is lying in a supine position and the level of surgery is verified fluoroscopically. Diskectomy and decompression are performed via an anterior approach. After preparation of the implant bed, the center of the disk space is established using a transverse centering tool and inserting the Bryan cervical distractor. Before the prosthesis can be inserted, the end plates have to be milled. The prosthesis is filled with sterile saline solution and inserted. Proper fitting is verified fluoroscopically. POSTOPERATIVE MANAGEMENT: Depending on the clinical situation postoperatively, the patient is discharged. Wound clamps are distracted on day 8, support by a cervical collar is not necessary. Light physical manipulations for muscle relaxation can be performed. RESULTS: Since 2002, 178 patients have received at least one Bryan Cervical Disc Prosthesis. 92 patients had a complete follow- up. Examinations were performed 8 and 12 weeks, respectively, as well as 6 up to 44 months postoperatively. 29 patients received a hybrid implantation. Cobb's angle and range of motion were determined radiologically, the degree of heterotopic ossification was classified according to McAfee. Disk prosthesis placement was measured in relation to the dorsal edge of the vertebral body, the center of the spine, as well as the body axes. For clinical evaluation, the Oswestry Neck Disability Index was used, and the neurostatus was determined.
Authors: Luiz Pimenta; Paul C McAfee; Andy Cappuccino; Bryan W Cunningham; Roberto Diaz; Etevaldo Coutinho Journal: Spine (Phila Pa 1976) Date: 2007-05-20 Impact factor: 3.468
Authors: Jan Goffin; Adrian Casey; Pierre Kehr; Klaus Liebig; Bengt Lind; Carlo Logroscino; Vincent Pointillart; Frank Van Calenbergh; Johannes van Loon Journal: Neurosurgery Date: 2002-09 Impact factor: 4.654