Advertisement

European Spine Journal

, Volume 26, Issue 2, pp 546–557 | Cite as

Treating multi-level cervical disc disease with hybrid surgery compared to anterior cervical discectomy and fusion: a systematic review and meta-analysis

  • Victor M. LuEmail author
  • Lucy Zhang
  • Daniel B. Scherman
  • Prashanth J. Rao
  • Ralph J. Mobbs
  • Kevin Phan
Review Article

Abstract

Purpose

The traditional surgical approach to treat multi-level cervical disc disease (mCDD) has been anterior cervical discectomy and fusion (ACDF). There has been recent development of other surgical approaches to further improve clinical outcomes. Collectively, when elements of these different approaches are combined in surgery, it is known as hybrid surgery (HS) which remains a novel treatment option. A systematic review and meta-analysis was conducted to compare the outcomes of HS versus ACDF for the treatment of mCDD.

Methods

Relevant articles were identified from six electronic databases from their inception to January 2016.

Results

From 8 relevant studies identified, 169 patients undergoing HS were compared with 193 ACDF procedures. Operative time was greater after HS by 42 min (p < 0.00001), with less intraoperative blood loss by 26 mL (p < 0.00001) and shorter return to work by 32 days (p < 0.00001). In terms of clinical outcomes, HS was associated with greater C2–C7 range of motion (ROM) preservation (p < 0.00001) and less functional impairment (p = 0.008) after surgery compared to ACDF. There was no significant difference between HS and ACDF with respect to postoperative pain (p = 0.12). The postoperative course following HS was not significantly different to ACDF in terms of length of stay (p = 0.24) and postoperative complication rates (p = 0.18).

Conclusions

HS is a novel surgical approach to treat mCDD, associated with a greater operative time, less intraoperative blood loss and comparable if not superior clinical outcomes compared to ACDF. While it remains a viable consideration, there is a lack of robust clinical evidence in the literature. Future large prospective registries and randomised trials are warranted to validate the findings of this study.

Keywords

Anterior cervical discectomy and fusion Hybrid surgery Artificial disc replacement Arthroplasty Anterior cervical corpectomy and fusion Cervical disc disease Multi-level Range of motion Systematic review Spine 

Notes

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest of funding sources to disclose.

Supplementary material

586_2016_4791_MOESM1_ESM.eps (386 kb)
Supplementary material 1 (EPS 386 kb)
586_2016_4791_MOESM2_ESM.eps (376 kb)
Supplementary material 2 (EPS 376 kb)
586_2016_4791_MOESM3_ESM.eps (398 kb)
Supplementary material 3 (EPS 397 kb)

References

  1. 1.
    Matsumoto M, Yoshikazu F, Suzuki N et al (1998) MRI of cervical intervertebral discs in asymptomatic subjects. J Bone Joint Surg Br 80(1):19–24CrossRefPubMedGoogle Scholar
  2. 2.
    Siivola SM, Levoska S, Tervonen O, Ilkko E, Vanharanta H, Keinanen-Kiukaanniemi S (2002) MRI changes of cervical spine in asymptomatic and symptomatic young adults. Eur Spine J 11(4):358–363CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Rao RD, Gourab K, David KS (2006) Operative treatment of cervical spondylotic myelopathy. J Bone Joint Surg Am 88(7):1619–1640PubMedGoogle Scholar
  4. 4.
    Bohlman H, Emery S, Goodfellow D, Jones P (1993) 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 75(9):1298–1307CrossRefPubMedGoogle Scholar
  5. 5.
    Hilibrand A, Carlson G, Palumbo M, Jones P, Bohlman HH (1999) radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 81(4):519–528CrossRefPubMedGoogle Scholar
  6. 6.
    Song KJ, Lee KB, Song JH (2012) Efficacy of multilevel anterior cervical discectomy and fusion versus corpectomy and fusion for multilevel cervical spondylotic myelopathy: a minimum 5-year follow-up study. Eur Spine J 21(8):1551–1557CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Mummaneni PV, Kaiser MG, Matz PG et al (2009) Cervical surgical techniques for the treatment of cervical spondylotic myelopathy. J Neurosurg Spine 11(2):130–141CrossRefPubMedGoogle Scholar
  8. 8.
    Chen J, Xu L, Jia YS et al (2016) Cervical anterior hybrid technique with bi-level Bryan artificial disc replacement and adjacent segment fusion for cervical myelopathy over three consecutive segments. J Clin Neurosci 27:59–62CrossRefPubMedGoogle Scholar
  9. 9.
    Barbagallo GM, Assietti R, Corbino L et al (2009) 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 18(Suppl 1):29–39CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Cardoso MJ, Rosner MK (2010) Multilevel cervical arthroplasty with artificial disc replacement. Neurosurg Focus 28(5):E19CrossRefPubMedGoogle Scholar
  11. 11.
    Huppert J, Beaurain J, Steib JP et al (2011) Comparison between single- and multi-level patients: clinical and radiological outcomes 2 years after cervical disc replacement. Eur Spine J 20(9):1417–1426CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Ashkenazi E, Smorgick Y, Rand N, Millgram M, Mirovsky Y, Floman Y (2005) Anterior decompression combined with corpectomies and discectomies in the management of multilevel cervical myelopathy: a hybrid decompression and fixation technique. J Neurosug Spine 3(3):205–209CrossRefPubMedGoogle Scholar
  13. 13.
    Auerbach JD, Jones KJ, Fras CI, Balderston JR, Rushton SA, Chin KR (2008) The prevalence of indications and contraindications to cervical total disc replacement. Spine J 8(5):711–716CrossRefPubMedGoogle Scholar
  14. 14.
    Moher D, Liberati A, Tetzlaff J, Althman D (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PloS Med 6(7):e1000097CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Phan K, Mobbs RJ (2015) Systematic reviews and meta-analyses in spine surgery, neurosurgery and orthopedics: guidelines for the surgeon scientist. J Spine Surg. doi: 10.3978/jss.2015.06.01 Google Scholar
  16. 16.
    Stroup DF, Berlin JA, Morton SC et al (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 283(15):2008–2012CrossRefPubMedGoogle Scholar
  17. 17.
    Murrey D, Janssen M, Delamarter R et al (2009) 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. 9(4):275–286CrossRefPubMedGoogle Scholar
  18. 18.
    Ding F, Jia Z, Wu Y, Li C, He Q, Ruan D (2014) Fusion-nonfusion hybrid construct versus anterior cervical hybrid decompression and fusion: a comparative study for 3-level cervical degenerative disc diseases. Spine (Phila Pa 1976) 39(23):1934–1942CrossRefGoogle Scholar
  19. 19.
    Mao N, Wu J, Zhang Y et al (2015) A Comparison of Anterior Cervical Corpectomy and Fusion Combined With Artificial Disc Replacement and Cage Fusion in Patients With Multilevel Cervical Spondylotic Myelopathy. Spine (Phila Pa 1976) 40(16):1277–1283CrossRefGoogle Scholar
  20. 20.
    Bose B (2001) Anterior cervical instrumentation enhances fusion rates in multilevel reconstruction in smokers. J Spinal Disord 14(1):3–9CrossRefPubMedGoogle Scholar
  21. 21.
    Choi MK, Kim SB, Park CK, Kim SM (2016) Comparison of the clinical and radiologic outcomes obtained with single- versus two-level anterior cervical decompression and fusion using stand-alone PEEK cages filled with allograft. Acta Neurochir (Wien) 158(3):481–487CrossRefGoogle Scholar
  22. 22.
    Lau D, Chou D, Mummaneni PV (2015) Two-level corpectomy versus three-level discectomy for cervical spondylotic myelopathy: a comparison of perioperative, radiographic, and clinical outcomes. J Neurosurg Spine 23(3):280–289CrossRefPubMedGoogle Scholar
  23. 23.
    Phillips F, Carlson G, Emery S, Bohlman HH (1997) Anterior cervical pseudarthrosis. Natural history and treatment. Spine (Phila Pa 1976) 22(14):1585–1589CrossRefGoogle Scholar
  24. 24.
    Shen H, Buchowski J, Yeom JS, Liu G, Lin N, Riew KD (2010) Pseudarthrosis in multilevel anterior cervical fusion with rhBMP-2 and allograft. Spine 35(7):747–753CrossRefPubMedGoogle Scholar
  25. 25.
    Kan L, Kang J, Gao R, Chen X, Jia L (2014) Clinical and radiological results of two hybrid reconstructive techniques in noncontiguous 3-level cervical spondylosis. J Neurosurg Spine 21(6):944–950CrossRefPubMedGoogle Scholar
  26. 26.
    Kang L, Lin D, Ding Z, Liang B, Lian K (2013) Artificial disk replacement combined with midlevel ACDF versus multilevel fusion for cervical disk disease involving 3 levels. Orthopedics 36(1):e88–e94CrossRefPubMedGoogle Scholar
  27. 27.
    Grasso G (2015) Clinical and radiological features of hybrid surgery in multilevel cervical degenerative disc disease. Eur Spine J 24(Suppl 7):842–848CrossRefPubMedGoogle Scholar
  28. 28.
    Hey HW, Hong CC, Long AS, Hee HT (2013) Is hybrid surgery of the cervical spine a good balance between fusion and arthroplasty? Pilot results from a single surgeon series. Eur Spine J 22(1):116–122CrossRefPubMedGoogle Scholar
  29. 29.
    Ji GY, Oh CH, Shin DA, et al. (2015) Artificial disk replacement combined with fusion versus 2-level fusion in cervical 2-level disk disease with a 5-year follow-up. J Spinal Disord Tech, [Epub ahead of print] Google Scholar
  30. 30.
    Mende K, Kahl N, Detzner M, Lefering R, Franke J, Weber F (2015) Comparison of dual level fusion and hybrid treatment in the cervical spine based on patient outcome. J Spine 4(2):1–5Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Victor M. Lu
    • 1
    Email author
  • Lucy Zhang
    • 1
  • Daniel B. Scherman
    • 1
    • 2
  • Prashanth J. Rao
    • 1
    • 2
    • 3
  • Ralph J. Mobbs
    • 1
    • 2
    • 3
  • Kevin Phan
    • 1
    • 2
  1. 1.Sydney Medical SchoolThe University of SydneySydneyAustralia
  2. 2.NeuroSpine Surgery Research Group (NSURG)Prince of Wales Private HospitalSydneyAustralia
  3. 3.Department of NeurosurgeryPrince of Wales HospitalSydneyAustralia

Personalised recommendations