Weber Friedrich, Detzner Michael
Neurochirurgische Klinik, Kliniken der Stadt Köln gGmbH, Köln, Germany.
Oper Orthop Traumatol. 2010 Nov;22(5-6):468-79. doi: 10.1007/s00064-010-9031-8.
Treatment of radicular or myelopathic symptoms of the vertebral segments from C2 through Th1.
Discogenic and/or spondylotic radiculopathy. Acute myelopathy. Acute or progressive functional neurological deficit. Persistent pain resistant toward conservative treatment for > 6 weeks.
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.
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.
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.
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.
治疗C2至胸1椎体节段的神经根性或脊髓病性症状。
椎间盘源性和/或脊柱关节病性神经根病。急性脊髓病。急性或进行性功能性神经功能缺损。对保守治疗抵抗超过6周的持续性疼痛。
慢性脊髓病。脊柱关节病性脊髓病。感染。椎体节段肿瘤。后纵韧带骨化（OPLL）。代谢性骨病。骨质疏松症。长期使用类固醇药物。对钛、聚氨酯和环氧乙烷过敏。贝赫捷列夫病。骨节段融合。不稳定。
使用Bryan颈椎间盘模板套装以及磁共振或计算机断层扫描图像，选择假体的确切尺寸。患者仰卧位，通过荧光透视确认手术节段。经前路进行椎间盘切除术和减压。准备好植入床后，使用横向定心工具并插入Bryan颈椎撑开器确定椎间盘间隙中心。在插入假体之前，必须对终板进行铣削。假体填充无菌盐溶液后插入。通过荧光透视确认合适的贴合度。
根据术后临床情况，患者出院。术后第8天拆除伤口夹，无需颈托支撑。可进行轻度物理手法以放松肌肉。
自2002年以来，178例患者至少接受了一个Bryan颈椎间盘假体。92例患者进行了完整随访。分别在术后8周和12周以及术后6个月至44个月进行检查。29例患者接受了混合植入。通过放射学方法确定Cobb角和活动范围，根据McAfee对异位骨化程度进行分类。测量椎间盘假体相对于椎体后缘、脊柱中心以及身体轴线的位置。临床评估采用Oswestry颈部功能障碍指数，并确定神经状态。
