Exploration on sagittal alignment and clinical outcomes after consecutive three-level hybrid surgery and anterior cervical discectomy and fusion: a minimum of a 5-year follow-up

Abstract

Purpose To compare sagittal alignment and clinical outcomes between three-level hybrid surgery (HS) and anterior cervical discectomy and fusion (ACDF) on cervical spondylotic myelopathy (CSM) over a 5-year follow-up. Method The study included 32 patients with ACDF, 36 patients with 1 prosthesis and 2 cages (HS1 group), and 25 cases with 2 prostheses and 1 cage (HS2 group). Alignment parameters included C2–C7 cervical lordosis (CL), C2–C7 sagittal vertical axis (SVA), T1 slope (T1S), and T1S minus CL (T1SCL). Radiographic parameters were range of motion (ROM), upper and lower adjacent ROM (UROM and LROM), and operated-segment lordosis (OPCL), as well as adjacent segment degeneration (ASD). Clinical outcomes included the neck disability index (NDI) and Japanese Orthopedic Association (JOA) score. Results Three groups were well-matched in demographics. All groups gained comparable improvement on NDI and JOA (P < 0.01). All groups gained CL improvement at the final visit (P < 0.05). There were no statistical differences on SVA and T1SCL among the groups and among preoperation, 1 week later, and final follow-up (P > 0.05) while T1S improved at 1 week later and final follow-up with HS2. The final change of all alignment parameters among the three groups was of no differences. ROM decreased and OPCL increased in all groups at the final follow-up (P < 0.05). UROM and LROM increased with ACDF but kept stable with HS1 and HS2. There was no inter-group difference on the incidence of ASD (P > 0.05). Conclusion Cervical alignment was comparably improved. HS and ACDF provided identified mid-term efficacy, and it was not necessary to have to use prosthesis on three-level CSM.

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

“…In conclusion, the authors recommended the ACDF-CDA-CDA construct and three-level CDA for patients with C3–C6 disc degeneration without predisposing C2-3 conditions, and the ACDF-ACDF-CDA construct could be a good alternative with a lower medical cost. Xu et al [ 14 ] performed a clinical study that took different numbers of CDAs into consideration and compared the clinical outcomes and sagittal alignment among three-level ACDF, one-level ACDF combined with two-level CDA and one-level CDA combined with two-level ACDF. In the authors’ opinions, it was not necessary to performed CDA for three-level cervical spondylotic myelopathy (CSM).…”

“…Unlike two-level HS, according to the different numbers and locations of CDAs and ACDFs, three-level HS has many constructs. Some surgeons have demonstrated the differences among different constructs [ 11 – 14 ]. However, most of the studies are finite element analysis.…”

Assessment of spino cranial angle of cervical spine sagittal balance system after multi-level anterior cervical discectomy and fusion

“…It is widely approved multi-level ACDF could remove anterior pathogenic structures directly, which could lead to the extrusion of nerve tissue, such as protruded discs and osteophyte [7], which has been shown to be related to the correction of kyphosis and the maintenance of postoperative lordosis [8,9]. Nowadays, the influence of multi-level ACDF on sagittal balance has attracted more and more attention [10][11][12][13][14]. Given the important role of sagittal alignment in predicting postoperative clinical effect of MCSM, we are dedicated to studying the relationship between sagittal balance parameters and clinical efficacy increasingly.…”

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

“…The frequency of mCDD increases with age, more than 85% of the population older than 60 may suffer from severe degeneration at least at one cervical level. In the light of current literature, HC seems to be a safe and feasible treatment alternative for some patients with mCDD scheduled for operation using the anterior approach [ 12 , 13 ].…”