New Member – Advice Request About Bryan ADR

[JG81]

Hello everybody, I’m Jeff. After scouring the internet for information about cervical arthroplasty, I was very happy to find this site. You all are doing a great service for those suffering from spine-related pain.
However, I am concerned by the lack of information on this forum about the Bryan cervical disc. I saw Illinois neurosurgeon Dr. Taras Masnyk in June 2013, and he recommended a Bryan ADR for my C5-C6 disc. But, it appears Illinois only began allowing such procedures in October 2012.

I am very nervous about getting this procedure done, due to the lack of user experiences documented online. Most of the information I’ve found has come from medical studies and doctors. I have found almost nothing in terms of personal stories or experiences from the patients themselves. The patient experiences I have found are not comparable to my diagnosis.

I would love to know anything that anyone has to share about the Bryan disc. I have found all (or most of) the medical studies, which generally indicate an 80% to 92% success rate.

Please feel free to share anything you know about the Bryan disc.

I have a million questions, but some for you all would be:
- - Why does everyone seem to prefer the other discs available, instead of the Bryan disc?
- - Are there any unique risks posed by the Bryan disc that are not apparent with the competitors?
- - Does anyone know about “hypermobility” of the Bryan disc, which could lead to neck hyperextension? Is this true?

Being only 31, I would prefer to avoid a fusion, so ADR is really my only option besides nothing (except continuing chiropractic maintenance, which usually mildly improves my pain levels for 1-2 weeks).

I have constant pain on the right-middle side of my neck, which ranges from irritating to debilitating. I am considering surgery because the two times I injured my neck resulted from, 1) simply looking to my left in Sept. 2009, and 2) yawning in front of my closet in Oct. 2011. I am worried that some normal action will cause me further injury, and Dr. Masnyk claims my herniation is a 7.5 out of 10 in severity. That makes me think I need to act before it gets too much worse.

You can view my MRI analysis and the most poignant image via my signature, or just go to my photo album on this site.

I'm currently awaiting pre-certification for the surgery, so I am not yet sure if my insurance will cover it. I have been led to believe, though, that it will likely be covered. I am very lucky in that respect, having read many of your stories of struggles with coverage, and the great lengths people have gone to to get an ADR surgery. I also realize I am very lucky to have my injury contained to one level, so I feel a bit unworthy of posting my plight on this forum. But I figured I would try anyway.

Thank you very much for reading. I appreciate it. Also, thank you to anyone who is willing to respond.

I’m sorry this is so long. But I’m glad I found you all.

Note: The next post shows my MRI analysis, as well as the most poignant image.

[JG81]

To save you some time, I'm posting my MRI image and full doctor analysis as a reply to my original post.

MRI ANALYSIS 5/22/13 by Dr. Gregory J. Zweig:

Procedure: MRI Cervical Spine w/o Contrast
Technique: Multiplanar spin-echo, STIR and gradient echo sequences

Findings: There are no compression deformities of the vertebral bodies. No tonsillar herniation is seen. Signal in the visualized cervical spinal cord is within normal limits. Normal signal in the visualized bone marrow. The bony spinal canal is congenitally slightly narrow in AP diameter.

C1-C2: Unremarkable
C2-C3: Unremarkable
C3-C4: Subtle uncovertebral osteophytes. Slight narrowing of the neural foramina. Central canal is open.
C4-C5: Minimal central disc protrusion. No spinal stenosis.
C5-C6: Moderate sized broad-based central to right foraminal disc protrusion compressing the ventral aspect of the spinal cord at and well to the right of midline. Prominent narrowing of the right lateral recess and right neural foramen. The left neural foramen is open.
C6-C7: Subtle desiccation of the disc. No focal herniation or spinal stenosis.
C6-T1: Unremarkable

Impression: The major finding is right-sided disc herniation at C5-C6.

[TPatti]

I would suggest getting opinions from both US doctors and European doctors. As you can see on this site Dr. Bierstedt and Dr. Clavel are probably good choices to start for European opinions.

[annapurna]

I'll avoid some of your questions and instead choose to answer one you didn't ask: it's still true, with all of the marketing hype about different ADRs, that the number one way to get a ADR to work is to choose the right surgeon and the number one way to get it to fail is to choose the wrong surgeon. If you're sure that your proposed surgeon has one year's experience or less, I'd ask a whole lot of question about what he's done in that year and seriously consider seeking surgery elsewhere. This isn't something to panic about but, as I've advised people many times, don't allow yourself to wake up from surgery and wish you'd used the other surgeon. Make sure you're happy before you get the procedure.

As you're in Illinois, you might want to contact Dr. Hauser in the Chicago area. He's a prolotherapist and is treating other ADR c-spine ADR receipient for hypermobility and could give you his opinion of the problem and what he's doing to help those suffering from it. That's also not directly answering your question but it might be a more practical answer and potentially even set you up with a doctor in case you need follow-up.

[jss]

JG,

Let me first ditto Jim/Laura; easily the most important part of the ADR decision equation is finding the right surgeon. While it takes a LOT of research to answer that question, I'll go ahead and throw out Jack Ziglar at Texas Back in Plano, TX. If you use him you'll get a ProDisc, which I dislike intensely, but I'd challenge you to find a bad outcome at his scalpel.

When I was researching my ADR insurance appeal, the Bryan disc routinely appeared in medical documentation. One common theme with it was that within the 2yr follow up of the FDA studies that it produced about a 10% autofusion rate. I suspect that this nasty complication is why you don't hear of its employment in the US or Europe; because you don't see that autofusion rate with ProDisc, Prestige, M6, et al.

Good luck, Jeff

[Harrison]

Jeff, this doctor has appr. 13 years of ADR experience and many more as a surgeon:

Dr. Fred H. Geisler, Neurosurgeon, Chicago, IL, 60625

I met him a few times and he's a straight-shooter.

[Surprised 1]

Jeff, my first question is why did the doctor suggest this particular implant in your case? I just did a quick google search on the Bryan and came across a support forum (CareCure Forums) - possibly Canadian - and there's at least one thread on the board about difficulty w/ the Bryan.

Like you, my surgeon has recommended an ADR that I can't find much patient experience with however, I do understand why he has chosen the particular implant in my situation. Through boards I have read about ADR's without stops (such as the Bryan and the Secure-C) causing facet problems. I brought this concern forward and was told that the ligaments and muscles of the neck stop the rotation of the neck - not the facets. We shall see.

Best to you,
Susan

[LauraB]

Jeff,
As you are now aware, many US surgeons are restricted to the treatment and device available for disc replacement/repair. Due to FDA limitations, restrictions, and regulations, your options here in the US, although may be appropriate for your pathology, are confined to a sparse few. In my own experience, my surgeon could only suggest 3 level fusion since the FDA is opposed to an ADR adjacent to an existing fused level. When I questioned his treatment choice, he shrugged his shoulders and told me he wouldn't get paid (via insurance) with any other nonconservative treatment.

It would be extremely prudent for you to solicit some of the US doctors that are well-trained and experienced in ADR; as well as sending your information out to the European surgical market, as well. It doesn't cost you anything, but will leave you with "peace of mind." I would urge you to fill out the questionnaire for Dr. Bierstedt (Germany), Dr. Clavel (Barcelona), and Dr. Dare (London). There are more, but I'm not sure if they charge a consultation fee. You can upload your diagnostic reports and they will contact you with a treatment plan. Then you will have multiple opinions to choose some.

You asked about the Bryan Disc. As I am not familiar with it, I want to provide you with a website that was extremely educational for me in my research of ADR implantation and its reference to fusion, ossification, migration, etc.
bryan cervical disc - PubMed - NCBI
(There is a plethora of published medical studies and outcomes for the Bryan).

If you can't retrieve it, then google/bing "National Library of Medicine"
(under its heading - click on "PubMed.") In the search field at the top of the
page - enter "Bryan" - OR, you can search for cervical arthroplasty, etc.

Hope it helps.
Laura

[Cheryl0331]

motion preservation and shock absorption. you want to mimic the natural disc as much as possible.

[JG81]

Wow!!! Thank you all so very much for taking the time to share your thoughts about my situation. I truly appreciate it. This is a wonderful community and you all are so supportive. This is the best-ever response I’ve gotten to a forum post in my life. I had a busy weekend, and hoped to check the forum today to see maybe one or two replies. But holy cow, this is a great surprise.


@TPatti: Thanks. I have indeed seen multiple high recommendations of Bierstedt and Clavel a lot on this site. I’ll definitely have to contact them and at least see what the possibilities are.

@annapurna: Good point – thank you very much. I was focused more on the disc itself rather than the surgeon implanting it. This site has changed my perspective 180 degrees in that regard. Thanks for suggesting Dr. Hauser.

@jss: I am stunned to hear of a 10% autofusion rate with the Bryan disc. I’ve read many studies and I never found anything showing that. Frankly that changes everything, because 10% autofusion is too high for my comfort. After doing more research, I can now see that heterotopic ossification seems to occur in anywhere from 15% to 66% of people receiving ADR, but varies on the grade. Grade 1-2 appears to not be considered a fusion, while grade 3 and/or 4 are considered fusions. Complicating things is that a grade 1-2 H.O. usually leads to a grade 3 or 4 H.O. later in life. Reagrding the Bryan disc, Dr. Taras Masnyk told me I had a 95% “chance of success”. I’m interested to see what he has to say about H.O. and many of these other complications. Thank you.

@Harrison: Thank you for suggesting Dr. Geisler based on my location. I’m now building a list of recommended doctors, so I can begin contacting them to see about some potential consultations. He could be a great guy, since he’s close enough that I could actually see him in person.

@Surprised_1: Thanks, Susan. Actually the CareCure forum complaint about the Bryan disc was one of the first things I found online when I began researching the Bryan disc – ugh. I definitely plan on asking about hypermobility and the effects of cutting the posterior longitudinal ligament (which appears to be standard with the Bryan procedure). However, after finding the CareCure post, I was never able to find anyone else online who mentioned hypermobility (or the subsequent hyperextension) as a cause of the Bryan disc. Also the author appears to be especially bitter toward corporations, and he did not explain about his injury pre-surgery. Those two factors make me doubt the comparability of his case to my own, given that my single-level herniation is basically nothing compared to the conditions of most other folks on these forums. It all just begs more questions. I will definitely also be asking about facet-related risks of the Bryan procedure. Thank you!

@LauraB: Thank you very much! I did not realize doctors were so open to receiving my data and responding with a treatment plan. I would love to get some other doctors’ opinions. Before, I was not too concerned because I thought my big choice was simply: fusion or ADR? Now, I realize my choice is: which ADR? I started perusing the PubMed link you provided, and I immediately found an eight-year Bryan study, and more other links than I could count. I have some serious reading to do! Thank you, I really appreciate it.

@cherylstewart67: I’m not sure if your comment is why I should, or should not, use the Bryan disc. The fact that the Bryan disc mimics a natural disc is appealing, but it also appears that the more disc-like the ADR, the more likely it is to cause heterotopic ossification later (although I can’t be sure of that). If I have a 10% chance of auto-fusion after getting an ADR, it might be smart to just avoid any procedures for another 10+ years and live with the pain for now. I am so very unsure.

Now I think my best courses of action will be to start getting more doctors’ opinions, frankly by whoever is willing to propose a treatment plan without an in-person appointment (and without a fee). I will also continue researching online, starting with LauraB’s PubMed links.

I am very grateful for everyone’s time and care in responding to my post. I would be happy to read any other advice, suggestions, or ideas that anyone has to offer. But this is the best start I could hope for. Take care, everyone!