Typical Surgical Experience for the Patient

The 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.

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.