Adjacent Level Degeneration: Bryan Total Disc Arthroplasty Versus Anterior Cervical Discectomy and Fusion.

STUDY DESIGN: Prospective randomized, 2-center, clinical trial. OBJECTIVE: To prospectively compare adjacent level degeneration between the Bryan Cervical Disc Prosthesis and anterior cervical discectomy and fusion (ACDF), and assess the reliability of our measurements utilizing a method not previously described. SUMMARY OF BACKGROUND DATA: ACDF is a reliable and proven procedure for the treatment of radiculopathy and/or myelopathy. Despite a successful track record several limitations including adjacent segment degeneration/disease, loss of viscoelastic disc properties, perioperative immobilization, graft site morbidity, pseudarthrosis, and plating complications have been identified. An original driving force and theoretical basis for total disc arthroplasty was prevention of adjacent level degeneration. MATERIALS AND METHODS: Seventy-nine patients were enrolled and followed prospectively at 2 centers in a multicenter, Food and Drug Administration Investigational Device Exemption trial for the Bryan Cervical Disc arthroplasty. Neutral lateral radiographs were obtained preoperatively and postoperatively, and at 1-, 2-, 4-, and out to 7-year follow-up after surgery. The cephalad, adjacent level above the blinded procedure level was analyzed for all patients and time points by measuring the anteroposterior distance and the vertical disc height. A ratio was created using disc height/anteroposterior distance. RESULTS: Seventy patients (Bryan Cervical Disc N=34 and ACDF N=36) met inclusion criteria. Both fusion and arthroplasty groups showed a significant (P=0.001) decrease in disc height over time, indicative of adjacent level degeneration. Overall change in disc height between groups was not significantly different. Using our measurement technique, the overall interreviewer reliability was good [intrareviewer correlation coefficients (95% confidence interval)=0.77 (0.55-0.85)] and intrareviewer reliability was excellent [0.93 (0.91-0.94) and 0.85 (0.81-0.87)]. CONCLUSIONS: Adjacent level degeneration occurs in a similar manner in both the ACDF and total disc arthroplasty group. Our measurement technique is reliable and to the best of our knowledge not previously reported in the literature.

The Use of Tomosynthesis in the Global Study of Knee Subchondral Insufficiency Fractures.

RATIONALE AND OBJECTIVES: Subchondral insufficiency fractures (SIF), previously termed spontaneous osteonecrosis of the knee, are marked by a sudden onset of severe pain. Other than the size of the lesion, prediction for progression to joint replacement is difficult. The objective was to determine if quantitative analysis of bone texture using digital tomosynthesis imaging would be useful in predicting more rapid progression to joint replacement. MATERIALS AND METHODS: Tomosynthesis studies of 30 knees with documented SIF were quantified by fractal, mean intercept length (MIL), and line fraction deviation analyses. Fractal dimension, lacunarity, MIL, and line fraction deviation variables measured from these analyses were then correlated to short interval progression to joint replacement surgery. RESULTS: Higher odds for joint replacement were related to higher values of the standard deviation of slope lacunarity and to morphometric measures (eg, MIL). CONCLUSIONS: Using digital tomosynthesis images for bone texture assessment may help distinguish condylar bone response in SIF, potentially acting as a clinically relevant predictive tool. In the future, contrasting SIF to the more gradual long-term process of osteoarthritis, there may be a better understanding of the different mechanisms for the two conditions.