• World Neurosurg · Feb 2021

    Is cervical disc replacement valuable in three-level hybrid surgery compared with three-level anterior cervical discectomy and fusion?

    • Han Wang, Kangkang Huang, Hao Liu, Yang Meng, Xiaofei Wang, Chen Ding, and Ying Hong.
    • Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China.
    • World Neurosurg. 2021 Feb 1; 146: e151-e160.

    BackgroundCervical degenerative disc disease is common in clinical practice. Surgery is among the most effective treatments for patients with cervical radiculopathy, myelopathy, or stenosis. Which treatment is the best option for multilevel cervical degenerative disc disease is controversial. Hybrid surgery, combined cervical disc replacement and anterior cervical discectomy and fusion, may be an alternative treatment for multilevel cervical degenerative disc disease.MethodsSixty-four patients with 3-level hybrid surgery and 37 patients with 3-level anterior cervical discectomy and fusion were reviewed retrospectively. Clinical outcomes were based on visual analog scale, Neck Disability Index, 36-Item Short Form Survey, and Japanese Orthopaedic Association scores and Japanese Orthopaedic Association recovery rate. Radiologic assessments included range of motion (ROM) of C2-C7 and adjacent level and cervical lordosis of C2-C7. Perioperative parameters, fusion condition, and complications were assessed.ResultsThere were no statistical differences observed between the 2 groups for Japanese Orthopaedic Association, Neck Disability Index, or visual analog scale scores. The hybrid surgery group had better physical and mental 36-Item Short Form Survey scores than the fusion group at 1-year follow-up (physical component summary: 49.34 vs. 46.70, P = 0.012; mental component summary: 45.67 vs. 43.95, P = 0.004). ROM of C2-C7 and adjacent levels was less compromised in the hybrid group compared with baseline (64.60% vs. 51.34%, P < 0.001). Cervical lordosis was decreased with time in both groups but was acceptable at final follow-up, and both groups showed solid fusion.ConclusionsNormal ROM and solid fusion were achieved at both arthroplasty and arthrodesis levels. ROM of replacement levels in different locations of the 3-level construct was acceptable.Copyright © 2020 Elsevier Inc. All rights reserved.

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