Artificial Disc Versus Fusion: A Prospective, Randomized Study With 2-Year Follow-up on 99 Patients

Rick C. Sasso, MD; Joseph D. Smucker, MD; Robert J. Hacker, MD; John G. Heller, MD


Spine. 2007;32(26):2933-2940. 

In This Article


Although far from being an accepted standard, the concept of artificial disc replacement is gradually becoming a reality. The possibility of being able to minimize adjacent segment degeneration is exciting; however, much more intermediate and long-term outcome-based data are going to be necessary to prove that this technology supersedes the current gold standard of anterior fusion. Biomechanical studies demonstrate that disc replacement creates less adjacent level strain than fusion. Hopefully, with time, long-term studies will prove that this correlates to a lower incidence of adjacent level degeneration.

Recent clinical reports show promising early data suggesting that artificial disc replacement is comparable to fusion at least in the short-term. Wear studies suggest that there may be less potential for aseptic loosening than in large joint arthroplasty, although the reality of this will only be borne out with more follow-up time. While early reports of success in the United States with the TDR suggest that the intended effects are being achieved, the final results of arthroplasty with these devices and of cervical arthroplasty are pending the outcomes of long-term studies.

This study demonstrates the favorable outcomes of cervical disc arthroplasty using the Bryan disc in comparison to the gold-standard (ACDF) at 24 months. Follow-up in this study is similar in duration to published data of many other cervical arthroplasty devices under investigation in U.S. trials. Intermediate and long-term data collection will ultimately determine the feasibility of this device and technique for patients with cervical radiculopathy and myelopathy.


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