Comparison of Different Hybrid Techniques for the Treatment of Multilevel Cervical Degenerative Disc Disease–Analysis of Prospectively Collected Clinical, Radiologic, and Psychological Parameters

Abstract

Conventional surgical treatment of multilevel cervical disc disease is based on anterior cervical discectomy and fusion (ACDF). However, fusion alters the biomechanics of the spine, potentially resulting in accelerated adjacent segment degeneration. To improve clinical outcomes, hybrid surgery, combining cervical disc arthroplasty with fusion, has been developed. Cervical total disc replacement (TDR) has been shown to keep the motion of adjacent segment, and a dynamic cervical implant (DCI) was shown to provide cervical dynamic stability under nonfusion. However, curative and unwanted side effects of the new therapy options TDR and DCI for treating multilevel cervical degenerative disc disease are still unknown. This analysis is based on 88 patients treated for multilevel cervical degenerative disc disease with ACDF only (56 patients), DCI hybrid (17 patients), and TDR hybrid (15 patients) between June 2008 and November 2015. The mean follow-up was 19.5 months. Visual analog scale (VAS), Neck Disability Index, and quality-of-life measurements were assessed via questionnaires. The VAS scores decreased significantly in all 3 groups (P < 0.001), but the TDR group showed the greatest reduction in VAS score compared with ACDF and DCI (both P < 0.05). The overall range of motion (ROM) and the segmental ROM at the treated levels showed significant decreases in all 3 groups. Although there was no difference in the overall ROM at final follow-up among the operatively treated groups, the ROM of the treated segment was lowest in the ACDF group (P= 0.002). In terms of heterotopic ossification, patients undergoing TDR showed the best prognosis. These results indicate that both TDR hybrid and DCI hybrid are effective and safe procedures for the treatment of multilevel degenerative disc disease. However, there is no definitive evidence that DCI or TDR arthroplasty lead to better intermediate-term results than ACDF over an average observation time of 19.5 months.