Anterior hybrid construction of multilevel cervical disc disease and spondylotic spinal stenosis: surgical results and factors affecting adjacent segment problems

Abstract

Objective We aimed to evaluate reliability, radiological outcomes, and the impacts of anterior cervical hybrid construction on the adjacent segments for the multilevel cervical degenerative disc disease (mCDDD) and spondylotic spinal stenosis (SSS). Methods A retrospective analysis was performed using data extracted from the medical files of 195 patients (105 males, 90 females; mean age: 47.7 years). From 2008 to 2018, these patients underwent anterior cervical hybrid construction for symptomatic contiguous at least 2-level cervical degenerative disc diseases and cervical spondylosis. Clinical and radiological data including Neck Disability Index (NDI), visual analogue scale (VAS), local cervical degenerative disk disease in adjacent segments on magnetic resonance imaging (MRI) views, and complications were reviewed. Results The mean clinical and radiological follow-up was 45.2 months (range 24 to 102). Radiculopathy and/or myelopathy were the main clinical problems in all patients. The mean VAS scores of HC for arm pain were 7.4 ± 0.8 preoperatively; 2.8 ± 0.6, 1 month after surgery; 2.3 ± 0.6, 6 months after surgery; 1.8 ± 0.6, 12 month after surgery; and 1.6 ± 0.6, 24 months after surgery. The mean NDI scores (mean ± SD) of HC significantly improved after surgery (on admission, 57.2 ± 5.5%; 1 month after surgery, 27.35 ± 5.3%; 6 month after surgery, 21.43 ± 2.8%; 12 months after surgery, 21.9 ± 2.3%; 24 months after surgery, 20.6 ± 2.6%, p = 0.006). Hoarseness and dysphagia were the most common complications and osteophyte formation was the most frequent radiographic change. Conclusion Anterior cervical hybrid construction appears to be an acceptable option in the management of multilevel cervical degenerative disc diseases and spondylotic spinal stenosis.

Biomechanical effects of hybrid constructions in the treatment of noncontinuous cervical spondylopathy: a finite element analysis

“…Our study showed that compared with intact FEM, HC mainly changed cervical movement characteristics in lateral bending and decreased the overall motion of the cervical spine. The possible reason is that ACDF changes the curvature of the cervical spine so that the cervical rotation centre shifts, and then the tension of cervical ligaments is increased by distraction [9,35]. We found that the hypermobility of the intermedial intervertebral disc of Group 1 was more obvious than in Group 2, which implied that the protective effect of Group 1 on the intermedial intervertebral segment is weak.…”

“…Cervical disc prosthesis, which is called cervical total disc replacement (TDR), can maintain physiological cervical movement instead of intervertebral fusion; this can decrease kinematic overloading at upper and lower adjacent segments [1]. TDR is usually carried out at the intervertebral level without instability or facet joint degeneration [9]. In addition, the facet joint can be overloaded at the TDR level, while the force transmission decreases at the adjacent levels [10,11].…”

“…Hybrid construction (HC) combines TDR and ACDF together [9]. Previous studies yield that HC could provide ideal clinical outcomes and radiologic parameters; in addition, HC would not significantly change the total range of motion (ROM) or the ROM of adjacent segments [9,12,13].…”

“…Hybrid construction (HC) combines TDR and ACDF together [9]. Previous studies yield that HC could provide ideal clinical outcomes and radiologic parameters; in addition, HC would not significantly change the total range of motion (ROM) or the ROM of adjacent segments [9,12,13]. HC may be an ideal surgical strategy than noncontinuous TDR and noncontinuous ACDF in the treatment of noncontinuous cervical spondylopathy.…”

[Retracted] Clinical Application of Evoked Potentials in the Operation of Cervical Spondylotic Myelopathy with Different Imaging

“…However, in recent years, somatosensory-evoked potential (SEP) is widely used by spine surgeons because of its high specificity to acute spinal cord and nerve injury. [1][2][3] Its application is easier, widely used, and simple and reliable results can be obtained, which is mainly used clinically in cervical spinal radiculopathy with compression of the spinal canal. The significant improvement of SEP waveform in most patients after spinal canal decompression can indicate that the compression is relieved and there is a good prognosis.…”