Skip to main content
SpringerLink
Log in

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?

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

We report the clinical and radiological results on the safety and efficacy of an unusual surgical strategy coupling anterior cervical discectomy and fusion and total disc replacement in a single-stage procedure, in patients with symptomatic, multilevel cervical degenerative disc disease (DDD). The proposed hybrid, single-stage, fusion–nonfusion technique aims either at restoring or maintaining motion where appropriate or favouring bony fusion when indicated by degenerative changes. Twenty-four patients (mean age 46.7 years) with symptomatic, multilevel DDD, either soft disc hernia or different stage spondylosis per single level, with predominant anterior myeloradicular compression and absence of severe alterations of cervical spine sagittal alignment, have been operated using such hybrid technique. Fifteen patients underwent a two-level surgery, seven patients received a three-level surgery and two a four-level procedure, for a total of 59 implanted devices (27 disc prostheses and 32 cages). Follow-up ranged between 12 and 40 months (mean 23.8 months). In all but one patient clinical follow-up (neurological examination, Nurick scale, NDI, SF-36) demonstrated significant improvement; radiological evaluation showed functioning disc prostheses (total range of motion 3–15°) and fusion through cages. None of the patients needed revision surgery for persisting or recurring symptoms, procedure-related complications or devices dislocations. To the authors’ best knowledge, this is the first study with the longest available follow-up describing a different concept in the management of cervical multilevel DDD. Although larger series with longer follow-up are needed, in selected cases of symptomatic multilevel DDD, the proposed surgical strategy appears to be a safe and reliable application of combined arthroplasty and arthrodesis during a single surgical procedure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Bertagnoli R, Yue JJ, Pfeiffer F et al (2005) Early results after ProDisc-C cervical disc replacement. J Neurosurg Spine 2:403–410

    Article  PubMed  Google Scholar 

  2. Duggal N, Pickett GE, Mitsis DK et al (2004) Early clinical and biomechanical results following cervical arthroplasty. Neurosurg Focus 17(3):62–68

    Article  Google Scholar 

  3. Mummaneni PV, Burkus JK, Haid RW et al (2007) Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion: a randomized controlled clinical trial. J Neurosurg Spine 6(3):198–209

    Article  PubMed  Google Scholar 

  4. Pickett GE, Mitsis DK, Sekhon LH et al (2004) Effects of a cervical disc prosthesis on segmental and cervical spine alignment. Neurosurg Focus 17(3):30–35

    Article  Google Scholar 

  5. Porchet F, Metcalf NH (2004) Clinical outcomes with the Prestige II cervical disc: preliminare results from a prospective randomized clinical trial. Neurosurg Focus 17(3):36–43

    Article  Google Scholar 

  6. Robertson JT, Metcalf NH (2004) Long-term outcome after implantation of the Prestige I disc in an end-stage indication: 4-year results from a pilot study. Neurosurg Focus 17(3):69–71

    Article  Google Scholar 

  7. Bryan VE (2002) Cervical motion segment replacement. Eur Spine J 11(Suppl 2):S92–S97

    PubMed  Google Scholar 

  8. Lafuente J, Casey AT, Petzold A et al (2005) The Bryan cervical disc prosthesis a san alternative to arthrodesis in the treatment of cervical spondylosis. J Bone Joint Surg Br 87(4):508–512

    Article  PubMed  CAS  Google Scholar 

  9. Pimenta L, McAfee PC, Cappuccino A et al (2007) Superiority of multilevel cervical arthroplasty outcomes versus single-level outcomes: 229 consecutive PCM prostheses. Spine 32(12):1337–1344

    Article  PubMed  Google Scholar 

  10. Sekhon LHS (2004) Cervical arthroplasty in the management of spondylotic myelopathy: 18-month results. Neurosurg Focus 17(3):55–61

    Article  Google Scholar 

  11. Sekhon LHS (2004) Two-level artificial disc placement for spondylotic cervical myelopathy. J Clin Neurosci 11(4):412–415

    Article  PubMed  Google Scholar 

  12. Kaiser MG, Haid RW Jr, Subach BR et al (2002) Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft. Neurosurgery 50:229–238

    Article  PubMed  Google Scholar 

  13. Matz PG, Pritchard PR, Hadley MN (2007) Anterior cervical approach for the treatment of cervical myelopathy. Neurosurgery 60(Suppl):64–70

    Article  Google Scholar 

  14. Ashkenazi E, Smorgick Y, Rand N et al (2005) Anterior decompression combined with corpectomies and discectomies in the management of multilevel cervical myelopathy: a hybrid decompression and fixation technique. J Neurosurg Spine 3:205–209

    Article  PubMed  Google Scholar 

  15. Wiggins GC, Shaffrey CI (2007) Dorsal surgery for myelopathy and myeloradiculopathy. Neurosurgery 60(Suppl):71–81

    Article  Google Scholar 

  16. DiAngelo DJ, Robertson JT, Metcalf NH et al (2003) Biomechanical testing of an artificial cervical joint and an anterior cervical plate. J Spinal Disord Tech 16:314–323

    PubMed  Google Scholar 

  17. DiAngelo DJ, Foley KT, Morrow BR et al (2004) In vitro biomechanics of cervical disc arthroplasty with Prodisc-C total disc implant. Neurosurg Focus 17(3):44–54

    Article  Google Scholar 

  18. DiAngelo DJ, Foley KT (2004) An improved biomechanical testing protocol for evaluating spinal arthroplasty and motion preservation devices in a multilevel human cadaveric cervical model. Neurosurg Focus 17(3):22–29

    Google Scholar 

  19. Goffin J, Geusens E, Vantomme N et al (2004) Long-term follow-up after interbody fusion of the cervical spine. J Spinal Disord Tech 17:79–85

    PubMed  Google Scholar 

  20. Hilibrand AS, Carlson GD, Palumbo MA et al (1999) Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 81:519–528

    PubMed  CAS  Google Scholar 

  21. Hilibrand AS, Robbins M (2004) Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J 4:190S–194S

    Article  PubMed  Google Scholar 

  22. Katsuura A, Hukuda S, Saruhashi Y et al (2001) Kyphotic malalignment after anterior cervical fusion s one of the factors promoting the degenerative process in adjacent intervertebral levels. Eur Spine J 10:320–324

    Article  PubMed  CAS  Google Scholar 

  23. Kulkarni V, Rajshekhar V, Raghuram L (2004) Accelerated spondylotic changes adjacent to the fused segments following central cervical corpectomy: magnetic resonance imaging study evidence. J Neurosurg Spine 1(100):2–6

    Article  Google Scholar 

  24. Robertson JT, Papadopoulos SM, Traynelis VC (2005) Assessment of adjacent-segment disease in patients treated with cervical fusion or arthroplasty: a prospective 2-year study. J Neurosurg Spine 3:417–423

    Article  PubMed  Google Scholar 

  25. Wang JC, McDonough PW, Endow K (1999) The effect of cervical plating on single-level anterior cervical discectomy and fusion. J Spinal Disord 12:467–471

    Article  PubMed  CAS  Google Scholar 

  26. Wigfield C, Gill S, Nelson R et al (2002) Influence of an artificial cervical joint compared with fusion on adjacent-level motion in the treatment of degenerative cervical disc disease. J Neurosurg Spine 1(96):17–21

    Article  Google Scholar 

  27. Gore DR, Sepic SB (1998) Anterior discectomy and fusion for painful cervical disc disease. A report of 50 patients with an average follow-up of 21 years. Spine 23:2047–2051

    Article  PubMed  CAS  Google Scholar 

  28. Albert TJ, Eichenbaum MD (2004) Goals of cervical disc replacement. Spine J 4:292S–293S

    Article  PubMed  Google Scholar 

  29. Oskouian RJ, Whitehill R, Samii A et al (2004) The future of spinal arthroplasty: a biomaterial perspective. Neurosurg Focus 17(3):10–14

    Article  Google Scholar 

  30. Smith HE, Wimberley DW, Vaccaro AR (2004) Cervical arthroplasty: material properties. Neurosurg Focus 17(3):15–21

    Article  Google Scholar 

  31. Coric D, Finger F, Boltes P (2006) Prospective randomized controlled study of the Bryan Cervical Disc: early clinical results from a single investigational site. J Neurosurg Spine 4:31–35

    Article  PubMed  Google Scholar 

  32. Cummins BH, Robertson JT, Gill SS (1998) Surgical experience with an implanted artificial cervical joint. J Neurosurg 88:943–948

    PubMed  CAS  Google Scholar 

  33. Goffin J, Casey A, Kehr P et al (2002) Preliminary clinical experience with the Bryan cervical disc prosthesis. Neurosurgery 51:840–847

    Article  PubMed  Google Scholar 

  34. Goffin J, Van Calenbergh F, van Loon J et al (2003) Intermediate follow-up after treatment of degenerative disc disease with the Bryan Cervical Disc Prosthesis: single-level and bi-level. Spine 28:2673–2678

    Article  PubMed  Google Scholar 

  35. Sekhon LHS, Sears W, Duggal N (2005) Cervical arthroplasty after previous surgery: results of treating 24 discs in 15 patients. J Neurosurg Spine 3:335–341

    Article  PubMed  Google Scholar 

  36. Traynelis VC (2004) The Prestige cervical disc replacement. Spine J 4:310S–314S

    Article  PubMed  Google Scholar 

  37. Wigfield CC, Gill SS, Nelson RJ et al (2002) The new Frenchay artificial cervical joint: results from a two-year pilot study. Spine 27:2446–2452

    Article  PubMed  Google Scholar 

  38. Le H, Thongtrangan I, Kim DH (2004) Historical review of cervical arthroplasty. Neurosurg Focus 17(3):1–9

    Article  Google Scholar 

  39. McAfee PC (2004) The indications for lumbar and cervical disc replacement. Spine J 4:177S–181S

    Article  PubMed  Google Scholar 

  40. Kettler A, Wilke H-J (2006) Review of existing grading systems for cervical and lumbar disc and facet joint degeneration. Eur Spine J 15:705–718

    Article  PubMed  Google Scholar 

  41. Yoon DH, Yi S, Shin HC et al (2006) Clinical and radiological results following cervical arthroplasty. Acta Neurochir (Wien) 148(9):943–950

    Article  CAS  Google Scholar 

Download references

Acknowledgments

The Authors would like to thank Professor Denis DiAngelo, Joint—Implant Biomechanics Laboratory, School of Biomedical Engineering, The University of Tennessee, USA, for his inputs and for kindly reviewing the manuscript. Sincere thanks also to Professor Giancarlo Ettorre, Chairman of the Radiology Department at the Azienda Ospedaliero-Universitaria Policlinico “G. Rodolico”, Catania, and to Ms Marisa Valastro, Radiographer, for her valuable technical support during this study.

Financial disclosure: none of the Authors has any financial interest in the products cited in this study. No funding from grant-giving organizations or other sources has been or will be received for any aspect of this work.

Conflict of interest satement

None of the authors has any potential conflict of interest.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Azienda Ospedaliero-Universitaria Policlinico “G. Rodolico”, Catania, Italy

    Giuseppe M. V. Barbagallo, Leonardo Corbino, Giuseppe Olindo, Vittorio Russo & Vincenzo Albanese

  2. Department of Radiology, Azienda Ospedaliero-Universitaria Policlinico “G. Rodolico”, Catania, Italy

    Pietro V. Foti

  3. Neurosurgical Unit, Fatebenefratelli and Ophtalmic Hospital, Milan, Italy

    Roberto Assietti

  4. Viale XX Settembre 45, 95129, Catania, Italy

    Giuseppe M. V. Barbagallo

Authors
  1. Giuseppe M. V. Barbagallo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roberto Assietti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Leonardo Corbino
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giuseppe Olindo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pietro V. Foti
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Vittorio Russo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Vincenzo Albanese
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giuseppe M. V. Barbagallo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Barbagallo, G.M.V., 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 18 (Suppl 1), 29–39 (2009). https://doi.org/10.1007/s00586-009-0978-9

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-009-0978-9

Keywords

Search

Navigation