Classification of three-level hybrid surgery for the treatment of cervical degenerative disc disease: a retrospective study of 108 patients

Abstract

Introduction According to the different numbers and locations of cervical disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF), three-level hybrid surgery (HS) has many constructs. The purpose of the present study was to introduce a classification system for three-level HS and compare the two types with each other and with ACDF. Methods A retrospective study was conducted involving patients with three-level cervical degenerative disc disease (CDDD) who underwent ACDF or HS in our hospital between June 2012 and May 2019. According to the different numbers and locations of ACDFs and CDAs, we classified the three-level HS into two types (type I: one-level CDA and two-level ACDF, and type II: two-level CDA and one-level ACDF). The differences of clinical and radiological outcomes were compared with each other and with three-level ACDF. Results A total of 108 patients were analyzed. The Neck Disability Index (NDI) of the ACDF group at 3 months postoperatively was significantly higher than that in the type I and type II groups (p < 0.05). The cervical lordosis was significantly lower in the ACDF group than that in the type I and II groups at 3 days, 6, 12 months postoperatively and the final follow-up (p < 0.05). The range of motion (ROM) of the total cervical spine decreased significantly in all three groups at 3, 6, and 12 months postoperatively and at the final follow-up (p < 0.05). The ACDF group was observed with the most severe loss of ROM of the total cervical spine, followed by the type I group. The type II group could preserve the most ROM of the total cervical spine. The ROM of adjacent segments increased most in the ACDF group, followed by the type I group. Conclusions Compared with ACDF, three-level HS may yield a faster recovery rate and superior radiological outcomes, such as a superiority in maintaining the cervical curvature and ROM of the total cervical spine and a smaller increase in the ROM of adjacent segments. The advantages were most remarkable in the type II group.

Cervical sagittal balance after consecutive three-level hybrid surgery versus anterior cervical discectomy and fusion: radiological results from a single-center experience

“…Xu et al 29 compared three-level HS (Prodisc-C and MC+) and ACDF through more than 5 years of follow-up, and most patients achieved cervical balance with HS and ACDF, but there was no difference in cervical sagittal alignment parameters between the two. However, in our previous research, we more accurately classi ed threesegment HS (Prestige-LP and Zero-P) as type I versus type II and showed that type II was superior in terms of cervical lordosis and range of motion 12 . The different prostheses and cages used may be the main factor in this difference.…”

“…(3) lesion segment con rmed by clinical symptoms and imaging (computed tomography (CT), magnetic resonance imaging (MRI), and X-rays); and (4) surgery on three levels between C3 and C7 12 . The exclusion criteria consisted of (1) previous surgery at the cervical spine or (2) the existence of cervical stenosis, osteoporosis, tumor, and infection.…”

“…One senior spine surgeon performed all HS or ACDF surgeries in this study. The surgery was performed as previously described 12 . A standard Smith-Robinson approach was used to reveal the surgical segment.…”

“…The exclusion criteria consisted of (1) previous surgery at the cervical spine or (2) the existence of cervical stenosis, osteoporosis, tumor, and infection. The indications of CDR at the lesion segment were according to previous studies, which were without instability (sagittal plane translation > 3 mm and sagittal plane angulation > 11°), without an absence of motion < 3°, without a disc height loss > 50%, and without facet joint degeneration 12 . If instability, bridging osteophytes, and facet degeneration were observed in the radiological images, ACDF was performed.…”

Cervical disc arthroplasty combined with two‐level ACDF for the treatment of contiguous three‐level cervical degenerative disc disease: A comparative study

“…4 We have confirmed that compared with ACDF, three-level HS may yield a faster recovery rate and superior radiological outcomes, such as a superiority in maintaining the cervical curvature and ROM of the total cervical spine and a smaller increase in the ROM of adjacent segments. 5 However, to date, the in vivo differences among different constructs of HS concerning threelevel CDDD have not been reported. The primary aim of the present study was to compare the in vivo differences among different hybrid constructs with one-level CDA and two-level ACDF.…”