The clinical effects of cervical anterior Hybrid surgery for cervical spondylosis

English Keywords:Cervical spondylosis  Hybrid surgery  Clinical effects

English Abstract:

  【Abstract】 Objectives: To evaluate the clinical effects of the Hybrid surgery. Methods: Inpatients who underwent Hybrid surgery from July 2017 to December 2019 were retrospectively reviewed. 56 patients (25/31 males/females) aged 54.23±8.72(34-72) years were enrolled, of which 40 cases underwent X-Ray. The cervical radiculopathy was in 36 cases, mixed cervical spondylosis in 12 cases, cervical spondylotic myelopathy in 7 cases, and sympathetic cervical spondylosis in 1 case. There were 39 cases with two-level lesion and 17 cases with three-level lesion. Clinical outcomes were assessed by the Tanaka Yasushi cervical spondylitis symptom scale 20 score(YT20 score), Japanese Orthopedic Association scale(JOA score). The changes of C2-7 Cobb angle, functional spinal unit (FSU) Cobb angle, C2-7 sagittal vertical axis (C2-7 SVA） and T1 slope (T1S) were observed at pre-operation and the final follow-up. Adjacent segment degeneration(ASD) evolution was evaluated by Goffin′s criteria on cervical X-ray film. Results: Of all the 56 patients, the operation time was 88-360min (175.25±55.97min), intra-operative blood loss was 10-20ml (14.91±4.21ml), drainage volume was 5-80ml(17.92±17.13ml), length of stay was 4-29d(11.20±5.70d), and follow-up period was 6-29 (11.59±6.11) months. Neck hematoma was shown in 1 case at 2d postoperatively. Compared with pre-operation, the data showed better YT20 (9.02±3.50 vs 17.18±3.24, P<0.05) and JOA score (14.38±1.93 vs 16.40±1.12, P<0.05) at the final follow-up, and the average improvement rate of JOA score was 81.12%(0%-100%). Compared with pre-operation, there were significant differences of C2-7 Cobb angle (1.59°±6.76° vs 5.60°±8.32°, P<0.05), FSU Cobb angle (8.64°±10.68° vs 11.91°±10.94°, P<0.05) at final follow-up. There were no significant differences of C2-7 SVA(17.63±8.54mm vs 17.79±10.67mm, P＞0.05), T1S(23.32°±7.25° vs 24.42°±7.10°, P＞0.05) between pre-operation and final follow-up. ASD rate after Hybrid surgery: the ASD rate of superior level on X-ray film was 20.00%, and 1 and 2 grade was 12.50% and 7.50% respectively; the ASD rate of inferior level was 16.22%, and 1 and 2 grade was 8.11% and 8.11% respectively. There were no significant differences between ASD and non-ASD in JOA score and YT20 score (P>0.05), and between the ASD rate of fusion segment located cephalad (40.00%) and replacement segment located cephalad (17.14%) (P>0.05); there was no significant difference of the ASD rate of fusion segment located caudal (20.00%) and replacement segment located caudal(0.00%)(P>0.05). Conclusions: Compared to pre-operation, the data showed better symptoms improved, C2-7 Cobb and FSU Cobb after 1 year of Hybrid surgery. However, the ASD rate was relatively high. The effect of surgical segment replacement or fusion on ASD was not significant, and the influencing factors of ASD after hybrid surgery need to be further observed.