Comparison between total disc replacement and hybrid construct at two lumbar levels with minimum follow-up of two years

Abstract

Cohort observational study level III.

Comparison of Mid- to Long-term Follow-up of Patient-reported Outcomes Measures After Single-level Lumbar Total Disc Arthroplasty, Multi-level Lumbar Total Disc Arthroplasty, and the Lumbar Hybrid Procedure for the Treatment of Degenerative Disc Disease

“…20,21 Andrieu et al found no statistical difference in pain relief (À3.9 points vs. À3.5 points for VAS) or reduction in ODI (À29.5% vs. À27.0%) between two-level TDA and two-level hybrid constructs, respectively, after 2 years of follow-up. 20 Similarly, in this study, the PROMs comparing the hybrid group and multilevel TDA were not statistically significant. However, after a linear mixed model was applied, the RMDQ in the hybrid group was better than the multi-level TDA group at 6 months by 1.1 points (95% CI: 0.4-1.9, P ¼ 0.003) and 1.5 point at 2 years (95% CI: 0.1-0.8, P ¼ 0.011).…”

“…This can be explained by the higher incidence of facet joint osteoarthritis in older patients (a contraindicated for TDA) and age-related degenerative processes that leads to multi-level pathology. 20 The premise behind the hybrid construct is to address multi-level DDD by matching pathology with technology, whereby levels with advanced degeneration, facet arthropathy, or segment instability are treated with ALIF while TDA is reserved for levels without significant segmental instability or facet arthropathy. 37 Despite the difference in age between the hybrid group and single- and multi-level TDA, the clinical outcomes for VAS-B, VAS-L, and RMDQ were similar.…”

“… 19 An alternative to multi-level TDA and multi-level ALIF is the hybrid procedure, which combines the motion preservation of TDA and stability from ALIF. 20 , 21 Other surgical preferences for treating DDD include transforaminal or posterior lumbar interbody fusion, and lateral based techniques. There is considerable evidence on the benefits of TDA 10 , 15 ALIF 22 , 23 and hybrid 9 , 21 , 24 , 25 constructs in treating symptomatic DDD with comparison studies showing similar clinical outcomes.…”

“…Another surgical option is to treat multi-level DDD with multi-level ALIF, although this can result in higher rates of CASP/RASP and increased nonunion rates 19 . An alternative to multi-level TDA and multi-level ALIF is the hybrid procedure, which combines the motion preservation of TDA and stability from ALIF 20,21 . Other surgical preferences for treating DDD include transforaminal or posterior lumbar interbody fusion, and lateral based techniques.…”

Disc Replacement in Lumbar Spine

“…Therefore, treatment is considered a therapeutic challenge. 3 In this sense, total disc replacement (TDR) has emerged as an alternative to overcome the negative effects of spinal fusion. 4 TDR has been receiving more attention in recent years.…”