Pivotal IDE Study of the BRYAN(R) Cervical Disc Prosthesis in the Treatment of DDD Versus ACDF

Bryan(R) Cervical Disc Prosthesis is indicated in skeletally mature patients for reconstruction of the disc from C3 to C7 following single level discectomy for intractable radiculopathy and/or myelopathy.

• ATLANTIS™ Cervical Plate System and allograft (Device), also known as cervical plate, plate, fusion, cervical fusion: Control treatment is commercially available allograft (without bone matrix paste) used in conjunction with the Medtronic Safamor Danek ATLANTIS™ Cervical Plate System.
• BRYAN Cervical Disc Prosthesis (Device), also known as disc, cervical disc, artificial disc, BRYAN: The intent is to treat stable degenerative disc disease by implanting the BRYAN Cervical Disc Prosthesis to provide motion like the normal cervical functional spinal unit.

Primary outcomes

• Improvement in patient pain and ability to function [24 months]: The self-administered Neck Disability Index patient questionnaire is used to assess patient pain and ability to function. A successful outcome will be declared if: Postoperative Score - Postoperative Score is ≥ 15.

Sex: All, ages: 21 Years to any

Inclusion Criteria:

The indication studied was degenerative disc disease (DDD) at a single level between C3 and C7 for any combination of disc herniation with radiculopathy, spondylotic radiculopathy, disc herniation with myelopathy, or spondylotic myelopathy.

The following additional inclusion criteria had to be present:

* At least 6 weeks unsuccessful conservative treatment, except in cases of myelopathy requiring immediate treatment (e.g., acute onset of clinically significant signs);
* Requirement for surgical treatment demonstrated by CT, myelography and CT, and/or MRI;
* Skeletally mature (≥ 21 years of age);
* Preoperative Neck Disability Index score of ≥ 30 and at least one clinical sign associated with level to be treated;
* Willing to sign informed consent and comply with protocol.

Exclusion Criteria:

Subjects were excluded if they had any of the following:

* Any of the following at the treated level:

  * Significant cervical anatomical deformity; e.g., ankylosing spondylitis, rheumatoid arthritis, etc.
  * Moderate to advanced spondylosis. Patients who demonstrate advanced degenerative changes. Such advanced changes are characterized by any one or combination of the following: bridging osteophytes, marked reduction or absence of motion, collapse of the intervertebral disc space of greater than 50% of its normal height;
  * Radiographic signs of subluxation greater than 3.5 mm;
  * Angulation of the disc space more than 11 degrees greater than adjacent segments;
  * Significant kyphotic deformity or significant reversal of lordosis;
* Axial neck pain as the solitary symptom;
* Previous cervical spine surgery;
* Metabolic bone disease, such as osteoporosis, defined as a BMD T-score equal to or worse than 2.5. If significant radiolucence is detected, a BMD scan in the spine, wrist, and femoral neck must be obtained.
* Active systemic infection or infection at the operative site;
* Known allergy or to titanium, polyurethane, or ethylene oxide residuals;
* Concomitant conditions requiring steroid treatment;
* Diabetes mellitus requiring daily insulin management;
* Extreme obesity, as defined by NIH Clinical Guidelines Body Mass Index;
* A medical condition that may interfere with the postoperative management program, such as advanced emphysema or Alzheimer's disease;
* A medical condition that may result in patient death prior to study completion: unstable cardiac disease, active malignancy;
* Pregnant;
* Current or recent alcohol and/or drug abuser requiring intervention;
* Signs of being geographically unstable, such as recent or pending divorce, or high level of job dissatisfaction.

• Sasso RC, Anderson PA, Riew KD, Heller JG. Results of cervical arthroplasty compared with anterior discectomy and fusion: four-year clinical outcomes in a prospective, randomized controlled trial. J Bone Joint Surg Am. 2011 Sep 21;93(18):1684-92. doi: 10.2106/JBJS.J.00476. PMID 21938372
• Heller JG, Sasso RC, Papadopoulos SM, Anderson PA, Fessler RG, Hacker RJ, Coric D, Cauthen JC, Riew DK. Comparison of BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion: clinical and radiographic results of a randomized, controlled, clinical trial. Spine (Phila Pa 1976). 2009 Jan 15;34(2):101-7. doi: 10.1097/BRS.0b013e31818ee263. PMID 19112337
• Results publication: Arnold PM, Anderson KK, Selim A, Dryer RF, Kenneth Burkus J. Heterotopic ossification following single-level anterior cervical discectomy and fusion: results from the prospective, multicenter, historically controlled trial comparing allograft to an optimized dose of rhBMP-2. J Neurosurg Spine. 2016 Sep;25(3):292-302. doi: 10.3171/2016.1.SPINE15798. Epub 2016 Apr 29. PMID 27129045

• Rick C Sasso, MD, Principal investigator, Indiana Spine Group