Clinical Outcomes of Cervical Hybrid Reconstructions: A Prospective Study

Abstract

Background: The study design was a prospective clinical cohort study. The aim of this study was to assess the patient-reported outcome measures (PROMs), patient satisfaction, as well as complication and reoperation rate of cervical hybrid procedures for symptomatic cervical multilevel degenerative disc disease (MLDDD). Cervical total disc replacement (CTDR) has been shown to be safe and effective for the treatment of degenerative pathologies. However, there is minimal PROMs data on the outcomes of combined CTDR and anterior cervical decompression and fusion procedures, commonly referred to as cervical hybrid surgery. Methods: Prospectively collected PROMs were analyzed from patients receiving cervical hybrid surgery for symptomatic cervical MLDDD. Between 2004 and 2016, data were collected preoperatively and postoperatively at 3, 6, and 12 months, then yearly thereafter. Patient reported outcome measures included patient satisfaction, visual analog score for neck and arm, and Neck Disability Index. Complication and reoperation rates were also assessed. Results: A total of 151 patients (80 males, 71 females) who had a minimum of 12 months follow up were included. The mean age was 53 years (range ¼ 24-81), and median follow up was 2 years (range ¼ 1-10). The median number of levels treated was 3, with 29.8%, 49.0%, and 21.2% of patients having 2, 3, and 4 levels treated, respectively. The most common indication for surgery was multilevel cervical spondylotic radiculopathy (52.8%), followed by combined cervical spondylotic radiculomyelopathy (16.7%), axial neck pain (16%), and cervical spondylotic myelopathy (13.9%). Improvement in pain and disability scores were both clinically and statistically significant (P , .001), and these improvements were sustained throughout the course of follow up. There was a 16% incidence of minor adverse events, and 3 (1.9%) reoperations. Conclusions: Cervical hybrid surgery for cervical MLDDD demonstrates favorable and sustained clinical outcomes at short-term to midterm follow up. Level of Evidence: 4. Clinical Relevance: Statistically and substantial clinical benefits can be achieved by cervical hybrid surgery, in the treatment of cervical pathologies including radiculopathy and myelopathy. The key principles is to follow strict indications, and to match technology with the pathology.

The fatty infiltration into cervical paraspinal muscle as a predictor of postoperative outcomes: A controlled study based on hybrid surgery

“…In the current study, improved clinical outcomes reflected by VAS, JOA score, and NDI demonstrated that HS effectively ameliorated neurological symptoms, consistent with previous findings reported by Scott-Young et al. ( 27 ). More importantly, numerous studies in the past linked muscle FI to postoperative pain or neurological deficits, particularly following lumbar spine and posterior cervical surgery ( 4 , 13 , 26 ).…”

Cervical Disc Arthroplasty for the Treatment of Noncontiguous Cervical Degenerative Disc Disease: Results of Mid‐ to Long‐Term Follow‐up

“…For instance, a segment with soft protrusions may be treated with CDA, while a segment with osteophytes and severe degeneration may require ACDF. In recent years, various clinical studies have shown that HS can yield satisfactory outcomes while preserving some level of mobility in the cervical spine for continuous two‐ or multi‐level CDDD 15,36,37 . Due to the skipped lesion, HS is considered to be a suitable option for noncontiguous CDDD, as there is a lower likelihood of the CDA level and ACDF level affecting each other.…”

“…In recent years, various clinical studies have shown that HS can yield satisfactory outcomes while preserving some level of mobility in the cervical spine for continuous two-or multi-level CDDD. 15,36,37 Due to the skipped lesion, HS is considered to be a suitable option for noncontiguous CDDD, as there is a lower likelihood of the CDA level and ACDF level affecting each other. Biomechanical studies have confirmed that the increase in ROM at adjacent segments after HS is lower than that observed with 2-level ACDF, indicating that HS has a less detrimental biomechanical effect on adjacent segments.…”

No Difference in Two-Year Revisions Between Hybrid Fusion and Two-Level Anterior Discectomy and Fusion: A National Database Study

“…Common contraindications are similar to those described for CDA and include advanced osteoporosis, facet arthropathy, or DDD. 33,34 Given the novel nature of HS, studies assessing long-term reoperation in HS are limited. Zigler et al found that in 115 hybrid surgeries followed for a mean of 6.5 years, only 6 required reoperation with 5 due to adjacent segment disease, and 1 due to pseudarthrosis.…”