J Korean Neurosurg Soc.  2017 Nov;60(6):676-683. 10.3340/jkns.2016.1010.013.

A Comparison of Anterior Cervical Discectomy and Fusion versus Fusion Combined with Artificial Disc Replacement for Treating 3-Level Cervical Spondylotic Disease

• Jang SR
• Lee SB
• Cho KS

• KMID: 2395787
• DOI: http://doi.org/10.3340/jkns.2016.1010.013

Abstract

OBJECTIVE
The purpose of this study is to evaluate the efficacy and safety of 3-level hybrid surgery (HS), which combines fusion and cervical disc replacement (CDR), compared to 3-level fusionin patient with cervical spondylosis involving 3 levels.
METHODS
Patients in the anterior cervical discectomy and fusion (ACDF) group (n=30) underwent 3-level fusion and the HS group (n=19) underwent combined surgery with fusion and CDR. Clinical outcomes were evaluated using the visual analogue scale for the arm, the neck disability index (NDI), Odom criteria and postoperative complications. The cervical range of motion (ROM), fusion rate and adjacent segments degeneration were assessed with radiographs.
RESULTS
Significant improvements in arm pain relief and functional outcome were observed in ACDF and HS group. The NDI in the HS group showed better improvement 6 months after surgery than that of the ACDF group. The ACDF group had a lower fusion rate, higher incidence of device related complications and radiological changes in adjacent segments compared with the HS group. The better recovery of cervical ROM was observed in HS group. However, that of the ACDF group was significantly decreased and did not recover.
CONCLUSION
The HS group was better than the ACDF group in terms of NDI, cervical ROM, fusion rate, incidence of postoperative complications and adjacent segment degeneration.

Keyword

Cervical spondylosis; Arthroplasty; Anterior cervical discectomy fusion; Total disc replacement

MeSH Terms

Arm
Arthroplasty
Diskectomy*
Humans
Incidence
Neck
Postoperative Complications
Range of Motion, Articular
Spondylosis
Total Disc Replacement*

Figure

• 

  Fig. 1 The cervical ROM is defined as the difference in the Cobb angle between the lateral ˛exion (C2–C7 Cobb, α) and extension (C2–C7 Cobb, β) view. ROM: range of motion.

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  Fig. 2 The VAS score for arm pain was significantly decreased in both groups. No difference was observed between the two groups at the last follow up. VAS: visual analogue scale, ACDF: anterior cervical discectomy and fusion, HS: hybrid surgery, POD: post operation day.

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  Fig. 3 The HS group shows better NDI relief than the ACDF group 6 months after surgery (p<0.05). NDI: neck disability index, ACDF: anterior cervical discectomy and fusion, HS: hybrid surgery, POD: post operation day.

• 

  Fig. 4 The cervical ROM of the HS group showed faster recovery than that of the ACDF group. ROM: range of motion, HS: hybrid surgery, ACDF: anterior cervical discectomy and fusion, POD: post operation day.

Reference

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