Clinical and Radiological Comparison of Hybrid Surgery and Fusion Application with Peek Cage in Patients Undergoing Three-Level Anterior Cervical Discectomy

Overview

Journal Indian J Orthop

Publisher Springer Nature

Specialty Orthopedics

Date 2022 Jul 11

PMID 35813542

Authors

Guray Bulut

Aziz Cataltepe

Mevlut Ozgur Taskapilioglu

Affiliations

Soon will be listed here.

Abstract

Objective: In this study, we aimed to compare patients with degenerative cervical disc herniation (CDH) who had undergone three-level anterior cervical discectomy (ACD) and fusion with a peek cage supported by synthetic bone graft in all levels to the cases with CDH with hybrid surgery (HS) regarding their radiological findings and surgical results.

Materials And Methods: The patients who had undergone three-level ACD were evaluated retrospectively. The cases who were followed up for 2 years and longer were evaluated regarding gender, age, radiological findings, and patient satisfaction. A radiological assessment was made by calculating the Cobb angle on lateral cervical radiographs. Clinical assessment was performed by the Neck Disability Index (NDI).

Results: In the first group, 13 patients had undergone ACD and fusion with peek cage and bone graft, and in the hybrid group, there were 11 patients in whom fusion with peek cage and bone graft were made in two levels, and cervical disc arthroplasty was performed throughout the distance in-between. In the hybrid group, the 1-month and 24-month changes in cervical range of motion in hyperflexion were statistically significant ( < 0.05). In both groups, significant improvements of NDI were determined postoperatively ( < 0.05). When the groups were compared, the 1-month and 24-month improvements were statistically significantly increased in the hybrid surgery group compared to the group that underwent fusion surgery with a cage ( < 0.05).

Conclusions: HS is a reliable and effective treatment method in the three-level cervical disk disease for preserving and improving cervical ROM, particularly in the flexion position.

Citing Articles

Cervical sagittal balance after consecutive three-level hybrid surgery versus anterior cervical discectomy and fusion: radiological results from a single-center experience.

Chen S, Deng Y, Liu H, Wu T, Huang K, He J J Orthop Surg Res. 2023; 18(1):345.

PMID: 37165448 PMC: 10170693. DOI: 10.1186/s13018-023-03819-0.

References

Hwang S, Lin C, Lieu A, Lee K, Kuo T, Hwang Y . Three-level and four-level anterior cervical discectomies and titanium cage-augmented fusion with and without plate fixation. J Neurosurg Spine. 2004; 1(2):160-7. DOI: 10.3171/spi.2004.1.2.0160. View

Davis R, Nunley P, Kim K, Hisey M, Jackson R, Bae H . Two-level total disc replacement with Mobi-C cervical artificial disc versus anterior discectomy and fusion: a prospective, randomized, controlled multicenter clinical trial with 4-year follow-up results. J Neurosurg Spine. 2014; 22(1):15-25. DOI: 10.3171/2014.7.SPINE13953. View

Telci E, Karaduman A, Yakut Y, Aras B, Simsek I, Yagli N . The cultural adaptation, reliability, and validity of neck disability index in patients with neck pain: a Turkish version study. Spine (Phila Pa 1976). 2009; 34(16):1732-5. DOI: 10.1097/BRS.0b013e3181ac9055. View

Eck J, Humphreys S, Lim T, Jeong S, Kim J, Hodges S . Biomechanical study on the effect of cervical spine fusion on adjacent-level intradiscal pressure and segmental motion. Spine (Phila Pa 1976). 2002; 27(22):2431-4. DOI: 10.1097/00007632-200211150-00003. View

ELsawaf A, Mastronardi L, Roperto R, Bozzao A, Caroli M, Ferrante L . Effect of cervical dynamics on adjacent segment degeneration after anterior cervical fusion with cages. Neurosurg Rev. 2008; 32(2):215-24. DOI: 10.1007/s10143-008-0164-2. View

Kang L, Lin D, Ding Z, Liang B, Lian K . Artificial disk replacement combined with midlevel ACDF versus multilevel fusion for cervical disk disease involving 3 levels. Orthopedics. 2013; 36(1):e88-94. DOI: 10.3928/01477447-20121217-24. View

Cheng L, Nie L, Zhang L, Hou Y . Fusion versus Bryan Cervical Disc in two-level cervical disc disease: a prospective, randomised study. Int Orthop. 2008; 33(5):1347-51. PMC: 2899108. DOI: 10.1007/s00264-008-0655-3. View

Wu T, Wang B, Deng M, Hong Y, Rong X, Chen H . A comparison of anterior cervical discectomy and fusion combined with cervical disc arthroplasty and cervical disc arthroplasty for the treatment of skip-level cervical degenerative disc disease: A retrospective study. Medicine (Baltimore). 2017; 96(41):e8112. PMC: 5662301. DOI: 10.1097/MD.0000000000008112. View

Cardoso M, Rosner M . Multilevel cervical arthroplasty with artificial disc replacement. Neurosurg Focus. 2010; 28(5):E19. DOI: 10.3171/2010.1.FOCUS1031. View

10.

Shin D, Yi S, Yoon D, Kim K, Shin H . Artificial disc replacement combined with fusion versus two-level fusion in cervical two-level disc disease. Spine (Phila Pa 1976). 2009; 34(11):1153-9. DOI: 10.1097/BRS.0b013e31819c9d39. View

11.

Kim S, Limson M, Kim S, Arbatin J, Chang K, Park M . Comparison of radiographic changes after ACDF versus Bryan disc arthroplasty in single and bi-level cases. Eur Spine J. 2009; 18(2):218-31. PMC: 2899339. DOI: 10.1007/s00586-008-0854-z. View

12.

Barbagallo G, Assietti R, Corbino L, Olindo G, Foti P, Russo V . Early results and review of the literature of a novel hybrid surgical technique combining cervical arthrodesis and disc arthroplasty for treating multilevel degenerative disc disease: opposite or complementary techniques?. Eur Spine J. 2009; 18 Suppl 1:29-39. PMC: 2899598. DOI: 10.1007/s00586-009-0978-9. View

13.

Fay L, Huang W, Tsai T, Wu J, Ko C, Tu T . Differences between arthroplasty and anterior cervical fusion in two-level cervical degenerative disc disease. Eur Spine J. 2013; 23(3):627-34. PMC: 3940787. DOI: 10.1007/s00586-013-3123-8. View

14.

Finn M, Samuelson M, Bishop F, Bachus K, Brodke D . Two-level noncontiguous versus three-level anterior cervical discectomy and fusion: a biomechanical comparison. Spine (Phila Pa 1976). 2011; 36(6):448-53. DOI: 10.1097/BRS.0b013e3181fd5d7c. View

15.

Bartels R, Goffin J . Albert Dereymaeker and Joseph Cyriel Mulier's description of anterior cervical discectomy with fusion in 1955. J Neurosurg Spine. 2018; 28(4):395-400. DOI: 10.3171/2017.7.SPINE17182. View

16.

Zhang J, Meng F, Ding Y, Li J, Han J, Zhang X . Hybrid Surgery Versus Anterior Cervical Discectomy and Fusion in Multilevel Cervical Disc Diseases: A Meta-Analysis. Medicine (Baltimore). 2016; 95(21):e3621. PMC: 4902346. DOI: 10.1097/MD.0000000000003621. View

17.

Dohrmann G, Hsieh J . Long-term results of anterior versus posterior operations for herniated cervical discs: analysis of 6,000 patients. Med Princ Pract. 2013; 23(1):70-3. PMC: 5586826. DOI: 10.1159/000351887. View

18.

Korinth M, Kruger A, Oertel M, Gilsbach J . Posterior foraminotomy or anterior discectomy with polymethyl methacrylate interbody stabilization for cervical soft disc disease: results in 292 patients with monoradiculopathy. Spine (Phila Pa 1976). 2006; 31(11):1207-14. DOI: 10.1097/01.brs.0000217604.02663.59. View

19.

Nandoe Tewarie R, Bartels R, Peul W . Long-term outcome after anterior cervical discectomy without fusion. Eur Spine J. 2007; 16(9):1411-6. PMC: 2200758. DOI: 10.1007/s00586-007-0309-y. View

20.

Lee J, Jung T, Kim H, Jang J, Lee S . Analysis of the incidence and clinical effect of the heterotopic ossification in a single-level cervical artificial disc replacement. Spine J. 2010; 10(8):676-82. DOI: 10.1016/j.spinee.2010.04.017. View