Two-Level Anterior Cervical Discectomy and Fusion Versus Hybrid Total Disc Replacement for Bilevel Pathology with Cervical Radiculopathy/Myelopathy: A Comparative Study with a Minimum 2-Year Follow-up in an Indian Population

Overview

Journal Asian Spine J

Date 2021 Nov 17

PMID 34784703

Citations 9

Authors

Jeevan Kumar Sharma

Kalidindi Kalyan Kumar Varma

Abhinandan Reddy Mallepally

Nandan Marathe

Tarush Rustagi

Bibhudendu Mohapatra

Padmini Yadav

Kalidutta Das

Affiliations

Soon will be listed here.

Abstract

Study Design: Retrospective study.

Purpose: To study the outcomes of two-level anterior cervical discectomy and fusion (2L-ACDF) versus hybrid total disc replacement (H-TDR) for cervical myeloradiculopathy.

Overview Of Literature: For bilevel disc issues of the cervical spine, 2L-ACDF has been a historical tool with numerous implants used at different time frames. Recent developments in total disc replacement at mobile level with fusion at a spondylotic level known as hybrid fixation have added a new armamentarium for such disorders.

Methods: An analysis of 49 consecutive patients who underwent 2L-ACDF (n=22) and H-TDR (n=27) from January 1, 2014 to December 31, 2017 was performed. Data were studied as retrieved from InstaPACS ver. 4.0 (Mediff Technologies Pvt. Ltd., Bengaluru, India) and medical records.

Results: Twenty-two patients with 2L-ACDF and 27 patients with H-TDR were included. The mean±standard deviation (SD) follow-up duration was 4.0±1.5 years in H-TDR and 3.1±1.1 years in 2L-ACDF. The mean±SD Neck Disability Index (NDI) decreased from 26.1±7.6 to 6.5±3.9 in the H-TDR group and from 27.6±7.2 to 6.4±4.8 in the 2L-ACDF group at final follow-up. Disc height at suprajacent level in the 2L-ACDF group was 4.12±0.48 mm, 4.10±0.45 mm, and 4.05±0.48 mm preoperatively, at 1-year, and final follow-up, respectively. Disc height at supradjacent level in the H-TDR group was 4.28±0.36 mm, 4.20±0.32 mm, and 4.19±0.34 mm preoperatively, at 1-year, and final follow-up, respectively.

Conclusions: There was significantly improved NDI in both groups. Adjacent segment disc height loss was greater in the 2L-ACDF group than in H-TDR but not statistically significant (p =0.304). Supradjacent segment range of motion was greater in the 2L-ACDF group than in the H-TDR group (p =0.003). Both findings supported radiographic adjacent segment degeneration (ASD), but symptomatic ASD was absent in both groups.

Citing Articles

Long-term effectiveness of stand-alone anchored spacer in multilevel anterior cervical discectomy and fusion compared with cage-plate system: a systematic review and meta-analysis.

Zhang Y, Ju J, Wu J Eur Spine J. 2024; 34(2):694-706.

PMID: 39694916 DOI: 10.1007/s00586-024-08613-y.

Meta-Analysis of Treatment for Adjacent Two-Segment Cervical Spondylotic Myelopathy: A Comparison Between Anterior Cervical Corpectomy and Fusion and Anterior Cervical Discectomy and Fusion.

Chen L, Zhang Z, Li J, Tong P, Xu T Global Spine J. 2024; :21925682241297586.

PMID: 39475621 PMC: 11559831. DOI: 10.1177/21925682241297586.

Cervical Disc Arthroplasty (CDA) versus Anterior Cervical Discectomy and Fusion (ACDF) for Two-Level Cervical Disc Degenerative Disease: An Updated Systematic Review and Meta-Analysis.

Chen C, Yang J, Wu C J Clin Med. 2024; 13(11).

PMID: 38892914 PMC: 11173267. DOI: 10.3390/jcm13113203.

Clinical and radiological outcomes of non-window-type bioactive glass-ceramic cage in single-level ACDF versus PEEK cage filled with autologous bone.

Kwon J, Lee Y, Lee B, Kim J, Suk K Sci Rep. 2024; 14(1):4035.

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Preoperative Radiographic Simulation for Partial Uncinate Process Resection during Anterior Cervical Discectomy and Fusion to Achieve Adequate Foraminal Decompression and Prevention of Vertebral Artery Injury.

Yang J, Kim H, Lee J, Park S Asian Spine J. 2023; 17(6):1024-1034.

PMID: 37946338 PMC: 10764128. DOI: 10.31616/asj.2023.0087.

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