Abstract
Introduction The use of unconstrained artificial cervical disc replacement (specifically the Bryan ® prosthesis) allows maintenance of normal cervical motion (unlike conventional fusion techniques) with the goal of alleviating neck and arm pain associated with spondylotic radiculopathy.
As a relatively new technique, there is little in the literature regarding patient satisfaction with this device and there are no long term trials defining the most appropriate indication for this device nor benefits over alternative and more conventional procedures such as discectomy and fusion. This study aimed to quantify the degree of disability and functional limitation in patients selected for Bryan disc replacement both pre-operatively and from 3 months post-operatively.
Methods The Oswestry Disability Index (ODI) and the SF36 Index were both used, being robust and reproducible tools in this setting. Patients completed questionnaires pre-operatively and from 3 months post-operatively. From 1 to 3 Bryan disc prostheses were implanted in the cervical spine at each operation. Post-operative index scores were compared with the pre-operative scores for 45 patients who completed all questionnaires, from a total of 47 operated patients in one practice (97% response, 69 total implants).
Results Patients reported a decrease in measured disability and an increase in general functioning and wellbeing after Bryan cervical disc replacement. Where 100% represents total and complete disability, the mean ODI improved from 43.65% pre-operatively (95% confidence interval 37.9 – 49.4) to 19.4% (14.0 – 24.9) post-operatively. Where 100% represents full and limitless functioning, the mean SF36 improved from 42.7% pre-operatively (36.7 – 48.6) to 64.9% (57.7 – 72.0) post-operatively. All the results were significant (p value < 0.05).
Discussion After single and multiple level Bryan cervical disc replacements in the cervical spine, there is significant decrease in perceived disability and pain as well as improvement in functional ability when compared to the pre-operative status of these patients. It is proposed that if undertaking cervical discectomy, maintenance of normal cervical motion where possible correlates with higher patient satisfaction when compared to more conventional cervical discectomy techniques.
The abstracts were prepared by Professor Bruce McPhee. Correspondence should be addressed to him at Orthopaedics Division, The University of Queensland, Clinical Sciences Building, Royal Brisbane & Women’s Hospital, Herston, Qld, Australia
