Is hybrid surgery of the cervical spine a good balance between fusion and arthroplasty? Pilot results from a single surgeon series

Abstract

Purpose: Few studies have investigated the role of hybrid surgery (HS) that incorporates anterior cervical discectomy and fusion (ACDF) and artificial disc replacement (ADR) techniques. To our knowledge, this is the first study that provides a direct comparison of all three groups in terms of intra-operative parameters and outcomes with a minimum follow-up of 2 years.

Methods: Seven consecutive patients who underwent HS were matched with another seven patients who underwent ACDF and ADR based on levels of surgery. Prospective data on demographics, pre-operative and post-operative assessments, complications and functional scores (VAS, NDI, EQ-5D health score and index) were analysed using Mann-Whitney U test. Type I error was set at 5 %.

Results: Duration of surgery was significantly shorter for ACDF at 135 min (p = 0.025) compared with HS and ADR. ACDF also had greater blood loss when compared with ADR (p < 0.036). ADR has the shortest duration of hospitalization followed by HS and ACDF (p < 0.031). The HS group returned to work fastest (54 days) when compared with both ACDF (107 days) and ADR (73 days) with statistical significance seen between HS and ACDF (p = 0.035). Cervical range of motion (ROM) and functional scores did not show any significant differences.

Conclusion: HS is comparable to ACDF and ADR in terms of safety and feasibility. Findings of shorter in-hospital stay and earlier return to work in HS group may be further explored in large, randomised controlled trials.

Fig. 1

a Angle subtended from superior endplate of C3 and inferior endplate of C7 used to measure global cervical spine movement (method 1). b Angle subtended from posterior border of C2 dens and posterior vertebral line of C7 used to measure global cervical spine movement (method 2)

Fig. 2

Anteroposterior and lateral X-rays of the cervical spine post hybrid surgery (C5/6 ADR and C6/7 ACDF)