Skip to main content

Main menu

  • Home
  • Content
    • Current Issue
    • Advance Online Publication
    • Archive
  • About Us
    • About ISASS
    • About the Journal
    • Author Instructions
    • Editorial Board
    • Reviewer Guidelines & Publication Criteria
  • More
    • Advertise
    • Subscribe
    • Alerts
    • Feedback
  • Join Us
  • Reprints & Permissions
  • Sponsored Content
  • Other Publications
    • ijss

User menu

  • My alerts

Search

  • Advanced search
International Journal of Spine Surgery
  • My alerts
International Journal of Spine Surgery

Advanced Search

  • Home
  • Content
    • Current Issue
    • Advance Online Publication
    • Archive
  • About Us
    • About ISASS
    • About the Journal
    • Author Instructions
    • Editorial Board
    • Reviewer Guidelines & Publication Criteria
  • More
    • Advertise
    • Subscribe
    • Alerts
    • Feedback
  • Join Us
  • Reprints & Permissions
  • Sponsored Content
  • Follow ijss on Twitter
  • Visit ijss on Facebook
EditorialEditorial

The Beginning of Cervical Arthroplasty

Vincent Bryan
International Journal of Spine Surgery April 2025, 19 (S2) S19; DOI: https://doi.org/10.14444/8741
Vincent Bryan
1 PreActive Technologies, Kirkland, Washington, USA
MD, FAANS
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: vince@preactive.tech
  • Article
  • Info & Metrics
  • PDF
Loading
  • cervical arthroplasty
  • artificial disc
  • degenerative disease

When I was a resident with Dr. Paul Bucy in 1970, the early work of Dr. Ralph Cloward in the surgical management of cervical spine degenerative disease was the current thinking. The simplicity of the procedures, the clever instrumentation, and the initial clinical results of cervical interbody fusion were impressive.

In the Pacific Northwest, fishing and crabbing, topping giant trees in the forests, and working in construction along the powerful rivers of the region—all the purview of young men—resulted in a disproportionate number of patients aged in their 20s with serious clinical manifestations of cervical disc degeneration. Their first anterior cervical discectomy and fusion solved the problem, as did the second procedure a year or 2 later, but several more years found them returning with additional adjacent-level symptoms. I asked myself, “Am I not actually, in 1 hour in the operating room, advancing the natural degenerative process by my surgical fusion? Am I accelerating adjacent level degeneration?”

At the completion of my residency, Dr. Bucy had said, “Remember, Vince, I didn’t just train you to practice neurosurgery but to advance it, because if you don’t, who’s going to do it?” I still recognize the universality of the message.

In 1991 in Capri, away from the hustle and bustle of back home, all the specifications and designs for the artificial disc, including a diarthrodial joint concept and the attending instrumentation, were conceived and preliminarily designed. It must be safe, allow no room for surgical error, replicate fully all motion and cushioning functions of the normal disc, and be inherently stable from day 1. It should require no screws, have a lifespan of at least 20 years—preferably a lifetime—and require no external temporary postoperative collar support. Additionally, the patient should be able to return to full work within days of the procedure.

I was convinced that the anatomical and functional features of the normal disc were there for a reason; a simple hinge was not the answer, shock absorption was required, and an upright animal model for testing was essential. From Chimpanzee Gigi, a remnant of the Sputnik space age, we were able to create the first chimp bone bank. That allowed us to proceed with a 2.5-year survival study in upright adult male chimpanzees (Drs. Paul Anderson and John Heller).

Could an artificial disc be both durable and resilient? The materials engineer at the Southwest Research Institute suggested polycarbonated polyurethane. Bob Wade at the University of California, Berkeley was able to modify the polymer, adding a silicon end group. A unique shape and layering manufacturing process were developed to account for the subtleties of multidirectional movement and load variations. Brilliant Swiss engineer Alex Kunzler designed precision, ultra-thin right-angle bits and drill and rig to exactly replicate the shape of the artificial disc shells so perfectly that once inserted, they were like a tight socket and could not move.

The energy created in the side rooms of major meetings by unscheduled presentations of the artificial cervical disc (Andy Handwerker) was quickly noted and, ultimately, through the work of many, gave rise to the concept of creating a society for spine arthroplasty.

Footnotes

  • Funding The author received no financial support related to this contribution.

  • Disclosures Founder, Chairman, and Chief Medical Officer at PreActive Technologies.

  • This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2025 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.
PreviousNext
Back to top

In this issue

International Journal of Spine Surgery: 19 (S2)
International Journal of Spine Surgery
Vol. 19, Issue S2
1 Apr 2025
  • Table of Contents
  • Index by author

Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on International Journal of Spine Surgery.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
The Beginning of Cervical Arthroplasty
(Your Name) has sent you a message from International Journal of Spine Surgery
(Your Name) thought you would like to see the International Journal of Spine Surgery web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
The Beginning of Cervical Arthroplasty
Vincent Bryan
International Journal of Spine Surgery Apr 2025, 19 (S2) S19; DOI: 10.14444/8741

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
The Beginning of Cervical Arthroplasty
Vincent Bryan
International Journal of Spine Surgery Apr 2025, 19 (S2) S19; DOI: 10.14444/8741
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Footnotes
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • A New Chapter for the International Journal of Spine Surgery: Global Perspective, Rapid Publishing, and Author-Centered Innovation
  • Editor’s Introduction: Recollections From the Past and Visions of the Future in Arthroplasty: The ISASS 25th Anniversary Special Issue
  • The Key Role of the International Society for the Advancement of Spine Surgery in Advancing Spine Arthroplasty
Show more Editorial

Similar Articles

Keywords

  • cervical arthroplasty
  • artificial disc
  • degenerative disease

Content

  • Current Issue
  • Latest Content
  • Archive

More Information

  • About IJSS
  • About ISASS
  • Privacy Policy

More

  • Subscribe
  • Alerts
  • Feedback

Other Services

  • Author Instructions
  • Join ISASS
  • Reprints & Permissions

© 2025 International Journal of Spine Surgery

International Journal of Spine Surgery Online ISSN: 2211-4599

Powered by HighWire