The clinical effects of cervical anterior Hybrid surgery for the treatment of contiguous 3-level cervical degenerative disc disease: a comparative study among different constructs

English Keywords:3-level cervical degenerative disc disease  Hybrid surgery  Anterior cervical discectomy and fusion  Constructs  Operative outcome

English Abstract:

  【Abstract】 Objectives: To explore the clinical effects of anterior cervical Hybrid surgery [anterior cervical discectomy and fusion(ACDF) + cervical disc arthroplasty(CDA)] for the treatment of contiguous 3-level cervical degenerative disc disease among different constructs. Methods: Between June 2012 and December 2018, data of patients with contiguous three levels cervical degenerative disc disease who underwent 3-level ACDF or 3-level anterior cervical Hybrid surgery in our hospital were reviewed. The patients were divided into FFF group(3-level ACDF), 1A2F group (1-level CDA and 2-level ACDF), and 2A1F group(2-level CDA and 1-level ACDF). According to the inclusion and exclusion criteria, a total of 98 patients were included with 22 patients in FFF group, 47 patients in 1A2F group, and 29 patients in 2A1F group. The average age in FFF group, 1A2F group and 2A1F group was 58.95±9.28 years, 51.70±8.23 years and 48.72±7.76 years, respectively. The average follow-up time in FFF group, 1A2F group and 2A1F group was 29.23±14.79 months, 36.09±16.72 months and 36.58±14.81 months, respectively. The differences of visual analog scale(VAS) scores of the neck and arm, the Japanese Orthopedic Association(JOA) scores and neck disability index(NDI) among groups were compared preoperatively and at 3 days, 3 months, 6 months, 12 months postoperatively and at the final follow-up. Cervical lordosis(CL), Cobb angle of surgical levels, range of motion(ROM) of the total cervical spine, ROM of surgical levels and ROM of the adjacent segments were measured via lateral X-rays in flexion-extension and neutral positions preoperatively and at 3 days, 3 months, 6 months, 12 months postoperatively and at the final follow-up. Fusion conditions were assessed according to flexion-extension X-rays and CT at the final follow-up. Results: After surgery, all patients in the three groups showed significant increase in JOA scores(P<0.05) and significant decrease in VAS scores of the neck and arm(P<0.05), yet there were no differences among the three groups(P>0.05). The NDI score in FFF group at 3 months postoperatively was 17.86±2.55, which was significantly higher than that of 1A2F and 2A1F groups(P<0.05), 15.13±3.76 and 15.55±4.07, respectively. The Cobb angles of the total cervical spine and the surgical levels were increased significantly at 3 days postoperatively compared with the value preoperatively in all three groups(P<0.05). However, at the final follow-up, the Cobb angles of the total cervical spine and the surgical levels were significantly lower than those preoperatively in FFF group(P<0.05). There were no significant differences of the Cobb angles of the total cervical spine and the surgical levels at the final follow-up among the three groups(P>0.05). The ROMs of the total cervical spine and the surgical levels in FFF group at 6, 12 months postoperatively and the final follow-up were significantly lower than those in 1A2F and 2A1F groups(P<0.05). The ROM of the total cervical spine in 2A1F group was significantly higher than those in 1A2F group at 12 months postoperatively(P<0.05). The ROMs of the surgical levels in 2A1F group were significantly higher than those in 1A2F group at 12 months postoperatively and the final follow-up(P<0.05). At the final follow-up, the ROMs of the superior adjacent segment of FFF group, 1A2F group and 2A1F group were 11.97°±2.27°, 9.80°±2.99° and 8.45°±2.26°, respectively, of which significant differences were observed among the three groups and between each two groups(P<0.05). At the final follow-up, fusion rate was 81.82%(18/22) in FFF group, 91.49%(43/47) in 1A2F group and 96.55%(28/29) in 2A1F group, without significant difference among groups(P>0.05). Conclusions: Compared with 3-level ACDF, the clinical outcomes of 3-level Hybrid surgery were satisfied. In addition, the Hybrid groups had a higher ROMs of the cervical spine and lower influence on the superior adjacent segment, especially in the group of 2-level CDA and 1-level ACDF construct.