Hybrid surgery of multilevel cervical degenerative disc disease : review of literature and clinical results

Abstract

Objective: In the present study, we evaluated the effect, safety and radiological outcomes of cervical hybrid surgery (cervical disc prosthesis replacement at one level, and interbody fusion at the other level) on the multilevel cervical degenerative disc disease (DDD).

Methods: Fifty-one patients (mean age 46.7 years) with symptomatic multilevel cervical spondylosis were treated using hybrid surgery (HS). Clinical [neck disability index (NDI) and Visual Analogue Scale (VAS) score] and radiologic outcomes [range of motion (ROM) for cervical spine, adjacent segment and arthroplasty level] were evaluated at routine postoperative intervals of 1, 6, 12, 24 months. Review of other similar studies that examined the HS in multilevel cervical DDD was performed.

Results: Out of 51 patients, 41 patients received 2 level hybrid surgery and 10 patients received 3 level hybrid surgery. The NDI and VAS score were significantly decreased during the follow up periods (p<0.05). The cervical ROM was recovered at 6 and 12 month postoperatively and the mean ROM of inferior adjacent segment was significantly larger than that of superior adjacent segments after surgery. The ROM of the arthoplasty level was preserved well during the follow up periods. No surgical and device related complications were observed.

Conclusion: Hybrid surgery is a safe and effective alternative to fusion for the management of multilevel cervical spondylosis.

Keywords: Anterior cervical discectomy and fusion; Hybrid; Multilevel cervical spondylosis; Total disc replacement.

Fig. 1

A : Tourniquet was inflated to extend the patient's neck to maintain the lordosis during the anterior cervical discectomy and fusion. Patient's neck shows extension on C-arm image. B : Tourniquet was deflated to place the patient's neck in a neutral position during the total disc replacement. Patients' neck shows neutral alignment on C-arm image.

Fig. 2

Radiographs illustrating how to measure the range of motion (ROM). The ROM of the whole cervical spine is defined as the difference in the Cobb's angle of C2-C7 between the flexion and extension view (A°). The ROM of upper adjacent segment (B°) and lower adjacent segment (C°) is defined as the difference in the Cobb's angle of adjacent level in the treated unit between the flexion and extension view. The ROM of arthroplasty level is calculated in the dynamic lateral simple radiographs (D°).

Fig. 3

The mean NDI scores decreased significantly in 2-level and 3-level HS. There is no difference between both groups. NDI : neck disability index, HS : hybrid surgery.

Fig. 4

The mean VAS scores decrease significantly in 2-level and 3-level HS. There is no difference between both groups. VAS : Visual Analogue Scale, HS : hybrid surgery.

Fig. 5

The ROM of cervical spine was recovered at 6 and 12 month after HS. There is no difference between both groups. ROM : range of motion, HS : hybrid surgery.

Fig. 6

The ROM of inferior adjacent segments is significantly larger than that of superior adjacent segments after HS. ROM : range of motion, HS : hybrid surgery.

Fig. 7

The mean range of ROM at arthroplasty level was from 3.8 degree to 12.4 degree. There are no significant changes of ROM at TDR level during the follow up periods. ROM : range of motion, TDR : total disc replacement, HS : hybrid surgery.