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  • Artificial Disc Replacement Combined With Fusion versus Two-Level Fusion in Cervical Two-Level Disc Disease with 5 Years Follow-up

    Final Number:
    402

    Authors:
    Gyu Yeul Ji MD; Chang Hyun Oh MD; Dong Ah Shin; Do heum Yoon; Keung Nyun Kim MD, PhD; Hyun Cheol Shin

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: In the previous study with 2 years follow-up, hybrid surgery(HS)is superior to 2-anterior cervical discectomy and fusion(2-ACDF) in terms of better neck disability index(NDI) recovery, less postoperative neck pain, faster C2–C7 range of motion(ROM) recovery, and less adjacent ROM increase.

    Methods: Between 2004 and 2006, 40 patients undergoing 2-level cervical disc surgery at our hospital were identified who met the following surgical indications: 2 consecutive level degenerative disc disease between C3/4 and C6/7; either a radiculopathy or myelopathy; and no response to conservative treatment for >6 weeks. Forty patients (20 patients of the HS group and 20 patients of the 2-ACDF group) were follow-up for 5 years. Patients were asked to check the neck disability index(NDI) and grade their pain intensity before surgery and at routine postoperative intervals of 1, 2, 3, 4, and 5 years. Dynamic flexion and extension lateral cervical radiographs were obtained in the standing position before surgery and at routine postoperative intervals. The angular ROM for C2-C7 and adjacent segments were measured using the Cobb method with PACS-software.

    Results: The HS group had better NDI recovery 1, 2 and 3 years after surgery(P<0.05). Postoperative neck pain was less in the HS group 1-3 years after surgery(P<0.05). There was no difference in arm pain relief between the groups. The HS group showed more angular ROM for C2-C7 at 2-3 years after surgery. The superior adjacent segment ROM shows hypermobility in the 2-ACDF group and hypomobility in the HS group at all follow-up period without statistical significance. The inferior adjacent segment ROM showed significant differences between the groups at 1-2 years after surgery(P<0.05).

    Conclusions: HS is superior to 2-ACDF(better NDI recovery, less postoperative neck pain, faster C2-C7 ROM recovery, and less adjacent ROM increase) in 2 years follow-up, but these benefits of HS becomes similar to 2-ACDF with 5 years follow-up.

    Patient Care: hybrid surgery is superior to 2-ACDF (better NDI recovery, less postoperative neck pain, faster C2-C7 ROM recovery, and less adjacent ROM increase)

    Learning Objectives: The purpose of this study was to compare the long-term(5 years)clinical and radiologic outcomes of HS, consisting of cervical artificial disc replacement(C-ADR) combined with ACDF and 2-level ACDF in patients with 2-level cervical disc disease.

    References: 1 Lee SB, Cho KS, Kim JY, et al. Hybrid surgery of multilevel cervical degenerative disc disease : review of literature and clinical results. J Korean Neurosurg Soc 2012 Nov;52:452-8. 2 Kang L, Lin D, Ding Z, et al. Artificial disk replacement combined with midlevel ACDF versus multilevel fusion for cervical disk disease involving 3 levels. Orthopedics 2013;36:e88-94. 3 Hey HW, Hong CC, Long AS, et al. Is hybrid surgery of the cervical spine a good balance between fusion and arthroplasty? Pilot results from a single surgeon series. Eur Spine J 2013 ;22:116-22. 4 Liu HY, Xu XN, Wang B, et al. Clinical outcomes of hybrid-surgery to treat the two-level cervical disease [abstract only]. Zhonghua Wai Ke Za Zhi 2012;50:238-42. 5 Barrey C, Campana S, Persohn S, et al. Cervical disc prosthesis versus arthrodesis using one-level, hybrid and two-level constructs: an in vitro investigation. Eur Spine J 2012;21:432-42. 6 Cardoso MJ, Mendelsohn A, Rosner MK. Cervical hybrid arthroplasty with 2 unique fusion techniques. J Neurosurg Spine 2011;15:48-54. 7 Lee MJ, Dumonski M, Phillips FM, et al. Disc replacement adjacent to cervical fusion: a biomechanical comparison of hybrid construct versus two-level fusion. Spine 2011;36:1932-9. 8 Cho BY, Lim J, Sim HB, et al. Biomechanical analysis of the range of motion after placement of a two-level cervical ProDisc-C versus hybrid construct. Spine 2010;35:1769-76. 9 Cunningham BW, Hu N, Zorn CM, et al. Biomechanical comparison of single- and two-level cervical arthroplasty versus arthrodesis: effect on adjacent-level spinal kinematics. Spine J. 2010;10(4):341-9. 10 Barbagallo GM, Assietti R, Corbino L, et al. 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;18:29-39. 11 Ashkenazi E, Smorgick Y, Rand N, et al. Anterior decompression combined with corpectomies and discectomies in the management of multilevel cervical myelopathy: a hybrid decompression and fixation technique. J Neurosurg Spine. 2005 Sep;3(3):205-9. 12 Shin DA, Yi S, Yoon DH, Kim KN, et al. Artificial disc replacement combined with fusion versus two-level fusion in cervical two-level disc disease. Spine 2009 May 15;34:1153-9. 13 Hilibrand AS, Carlson GD, Palumbo MA, et al. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 1999;81:519-28. 14 Bohlman HH, Emery SE, Goodfellow DB, et al. Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients. J Bone Joint Surg Am 1993;75:1298-307. 15 Bose B. Anterior cervical fusion using Caspar plating: analysis of results and review of the literature. Surg Neurol 1998;49:25-31. 16 Eck JC, Humphreys SC, Lim TH, et al. Biomechanical study on the effect of cervical spine fusion on adjacent-level intradiscal pressure and segmental motion. Spine 2002;27:2431-4. 17 Fuller DA, Kirkpatrick JS, Emery SE, et al. A kinematic study of the cervical spine before and after segmental arthrodesis. Spine 1998;23:1649-56. 18 Matsunaga S, Kabayama S, Yamamoto T, et al. Strain on intervertebral discs after anterior cervical decompression and fusion. Spine 1999;24:670-5. 19 Schwab JS, Diangelo DJ, Foley KT. Motion compensation associated with single-level cervical fusion: where does the lost motion go? Spine 2006;31:2439-48. 20 Duggal N, Pickett GE, Mitsis DK, et al. Early clinical and biomechanical results following cervical arthroplasty. Neurosurg Focus 2004;17:E9. 21 Emery SE, Bohlman HH, Bolesta MJ, et al. Anterior cervical decompression and arthrodesis for the treatment of cervical spondylotic myelopathy. Two to seventeen-year follow-up. J Bone Joint Surg Am. 1998;80:941-51. 22 Liu F, Cheng J, Komistek RD, et al. In vivo evaluation of dynamic characteristics of the normal, fused, and disc replacement cervical spines. Spine 2007;32:2578-84. 23 Pickett GE, Rouleau JP, Duggal N. Kinematic analysis of the cervical spine following implantation of an artificial cervical disc. Spine 2005;30:1949-54. 24 Robertson JT, Papadopoulos SM, Traynelis VC. Assessment of adjacentsegment disease in patients treated with cervical fusion or arthroplasty: a prospective 2-year study. J Neurosurg Spine. 2005;3:417-23. 25 Sasso RC, Smucker JD, Hacker RJ, et al. Artificial disc versus fusion: a prospective, randomized study with 2-year follow-up on 99 patients. Spine 2007;32:2933-40. 26 Yi S, Ahn PG, Kim DH, et al. Cervical artificial disc replacement. Part 2: clinical experience with the cervical artificial disc. Nuerosurg Q 2008;18: 96–103. 27 Yi S, Kim SH, Shin HC, et al. Cervical arthroplasty in a patient with Klippel-Feil syndrome. Acta Neurochir 2007;149:805-9. 28 Yi S, Shin HC, Kim KN, et al. Modified techniques to prevent sagittal imbalance after cervical arthroplasty. Spine 2007;32:1986-91. 29 Yoon DH, Yi S, Shin HC, et al. Clinical and radiological results following cervical arthroplasty. Acta Neurochir 2006;148:943-50. 30 Lee JH, Kim JS, Lee JH, et al. Comparison of cervical kinematics between patients with cervical artificial disc replacement and anterior cervical discectomy and fusion for cervical disc herniation. Spine J 2013 [Epub ahead of print] 31 McDonald CP1, Chang V, McDonald M, et al. Three-dimensional motion analysis of the cervical spine for comparison of anterior cervical decompression and fusion versus artificial disc replacement in 17 patients. J Neurosurg Spine 2013 [Epub ahead of print] 32 Vaccaro A, Beutler W, Peppelman W, et al. Clinical outcomes with selectively constrained SECURE-C cervical disc arthroplasty: two-year results from a prospective, randomized, controlled, multicenter investigational device exemption study. Spine 2013;38:2227-39. 33 Malham GM, Parker RM, Ellis NJ, et al. Cervical artificial disc replacement with ProDisc-C: Clinical and radiographic outcomes with long-term follow-up. J Clin Neurosci 2013 [Epub ahead of print] 34 Zhao YB1, Sun Y, Zhou FF, et al. Cervical disc arthroplasty with ProDisc-C artificial disc: 5-year radiographic follow-up results. Chin Med J 2013;126:3809-11. 35 Sasso RC, Anderson PA, Riew KD, et al. Results of cervical arthroplasty compared with anterior discectomy and fusion: four-year clinical outcomes in a prospective, randomized controlled trial. J Bone Joint Surg Am 2011;93:1684-92. 36 Hey HW, Hong CC, Long AS, et al. Is hybrid surgery of the cervical spine a good balance between fusion and arthroplasty? Pilot results from a single surgeon series. Eur Spine J 2013;22:116-22. 37 Pimenta L, McAfee PC, Cappuccino A, et al. Superiority of multilevel cervical arthroplasty outcomes versus single-level outcomes: 229 consecutive PCM prostheses. Spine 32:1337-44. 38 Cardoso MJ, Rosner MK. Multilevel cervical arthroplasty with artificial disc replacement. Neurosurg Focus 2010;28:E19. 39 Huppert J, Beaurain J, Steib JP, et al. Comparison between single- and multi-level patients: clinical and radiological outcomes 2 years after cervical disc replacement. Eur Spine J 2011;20:1417-26. 40 Upadhyaya CD1, Wu JC, Trost G, et al. Combined results of the 3 US IDE randomized cervical arthroplasty trials with 2-years of follow-up. Neurosurgery 2010;67:543. 41 Murrey D, Janssen M, Delamarter R et al. Results of the prospective, randomized, controlled multicenter Food and Drug Administration investigational device exemption study of the ProDisc-C total disc replacement versus anterior discectomy and fusion for the treatment of 1-level symptomatic cervical disc disease. Spine J 2009;9(4):275-86. 42 Sasso RC, Smucker JD, Hacker RJ, et al. Artificial disc versus fusion: a prospective, randomized study with 2-year follow-up on 99 patients. Spine 2007;32:2933-40. 43 Barbagallo GM, Assietti R, Corbino L, et al. 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:S29–S39. 44 Cardoso MJ, Mendelsohn A, Rosner MK. Cervical hybrid arthroplasty with 2 unique fusion techniques. J Neurosurg Spine 2011;15:48-54. 45 Shen C, Shen Y, Ding W, et al. Contrastive analysis of neck axial symptoms after hybrid surgery or traditional anterior cervical discectomy and fusion for treatment of two-level cervical disease [abstract only]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2013;27:58-61. 46 Ren X, Chu T, Jiang T, et al. Cervical Disc Replacement Combined With Cage Fusion for the Treatment of Multi-level Cervical Disc Herniation. J Spinal Disord Tech. 2012 Jul 24. [Epub ahead of print] 47 Liu HY, Xu XN, Wang B, et al. Clinical outcomes of Hybrid-surgery to treat the two-level cervical disease [abstract only]. Zhonghua Wai Ke Za Zhi 2012;50:238-42. 48 Kang L, Lin D, Ding Z, et al. Artificial disk replacement combined with midlevel ACDF versus multilevel fusion for cervical disk disease involving 3 levels. Orthopedics 2013;36:e88-94. 49 Galbusera F, Bellini CM, Costa F, et al. Anterior cervical fusion: a biomechanical comparison of 4 techniques. Laboratory investigation. J Neurosurg Spine 2008;9:444-9. 50 Silber JS, Anderson DG, Daffner SD, et al. Donor site morbidity after anterior iliac crest bone harvest for single-level anterior cervical discectomy and fusion. Spine 2003;28:134-9. 51 St John TA, Vaccaro AR, Sah AP, et al. Physical and monetary costs associated with autogenous bone graft harvesting. Am J Orthop 2003;32:18-23. 52 Summers BN, Eisenstein SM. Donor site pain from the ilium. A complication of lumbar spine fusion. J Bone Joint Surg Br 1989;71:677-80.

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