Single-Level Cervical Disc Arthroplasty with a Bryan Device.

Abstract

The anterior cervical approach for discectomy with modified distraction and milling tools (Video 1) provides an ideal method for surgical treatment of symptomatic discogenic disease and subsequent placement of an arthroplasty device. Position the patient supine on a radiolucent table that allows for anteroposterior and lateral fluoroscopic imaging. Use a standard Smith-Robinson approach to the anterior cervical spine at the index level of pathological involvement. Perform the initial discectomy with a modified distraction technique; then perform the index neurological decompression followed by bilateral neuroforaminal decompression. Size the end plates and eventual arthroplasty device, and mill the end plates. Prepare the arthroplasty device and insert it. Close the wound and incision in a fashion typical for a Smith-Robinson-type approach. Pain, neurological, and functional outcomes in the immediate perioperative period are at least similar, if not superior, to those achieved with arthrodesis, as are the outcomes over the ensuing months and years.