Anterior Cervical Discectomy and Fusion Versus Hybrid Decompression and Fusion for the Treatment of 3-Level Cervical Spondylotic Myelopathy: A Comparative Analysis of Cervical Sagittal Balance and Outcomes

Zhang, Xu; Rao, Hongming; Zhang, Liqun; Li, Guishuang; Xu, Zixing; Xu, Weili

doi:10.1016/j.wneu.2019.08.022

Cited by 11 publications

(11 citation statements)

References 20 publications

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“…The decision to treat multilevel cervical pathology with multilevel ACDF or corpectomy is one often faced by spine surgeons. As previously discussed, multilevel ACDF has previously been shown to result in greater restoration of lordosis, reduced operative time, blood loss and have a lower incidence of unplanned reoperations 3,5,6. Despite these advantages, others have shown an increased risk of pseudarthrosis because of the increased number of fusion surfaces in multilevel ACDF 4.…”

Section: Discussionmentioning

confidence: 99%

“…Hilibrand et al4 showed that multilevel ACDF had a higher nonunion rate, while ACCF had a higher rate of graft dislodgment and revision surgery. Several authors have reported shorter OR times, less blood loss, and better restoration of cervical lordosis with ACDF versus ACCF 3,5,6. Others have shown a correlation between the restoration of the cervical sagittal vertical axis(SVA) with improvement in patient-reported outcomes(PRO) 3,7…”

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confidence: 99%

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Correction and Maintenance of Cervical Alignment

Campion

Crawford

Glassman

et al. 2022

Clinical Spine Surgery: A Spine Publication

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Study Design: Longitudinal observational comparative cohorts. Objective: The objective of this study is to compare 3 and 12-month radiographic sagittal parameters and patient-reported outcomes (PROs) in patients who underwent 3-level ACDF or a hybrid procedure. Summary of Background Data: Anterior Cervical Discectomy and Fusion (ACDF), Anterior Cervical Corpectomy and Fusion (ACCF), and hybrids (combination ACCF-ACDF) are common procedures used to treat symptomatic cervical spondylosis. Although there is a relative abundance of literature comparing 1-level ACCF versus 2-level ACDF and 2-level ACCF versus 3-level ACDF, detailed comparisons of 3-level ACDF versus hybrid procedures have not been extensively addressed. Methods: Patients who underwent a 3-Level ACDF (3L-ACDF, N=47) or 1-Level Corpectomy/1-Level ACDF (Hybrid, N=52) with at least a 12-month post-op data available were identified. Standard demographic, surgical and PROs were collected in addition to preoperative and postoperative radiographic data, including C2 plumb line (C2PL), C2–C7 lordosis (CL), segmental lordosis (SL), and T1 slope (T1S). Results: The 2 cohorts were similar in terms of demographics. At 3 months post-op, CL (9.04° vs. −2.12°, P=0.00) and SL (6.06° vs. −2.26°, P=0.003) were significantly greater in the 3L-ACDF group versus the HYBRID group. This significant difference was maintained at 12 months postoperative for CL [(6.62° vs. −0.60°, P=0.015) but not for SL (2.36° vs. −1.09°, P=0.199)]. There were no differences in PROs between the 2 groups before surgery, at 3 months postoperative or 12 months postoperative. Seven patients required revision surgery in the 1-year study period (1 in the 3L-ACDF, and 6 in the Hybrid P<0.001). Conclusions: Three level ACDF resulted in greater C2–C7 lordosis and segmental lordosis postoperatively, which was maintained at 1 year for cervical lordosis. While PROs were similar between the groups, patients with hybrid instrumentation required significantly more revision surgeries than those treated with 3-level ACDF.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Correction and Maintenance of Cervical Alignment

Campion

Crawford

Glassman

et al. 2022

Clinical Spine Surgery: A Spine Publication

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“…Many factors should be considered when deciding on the surgical approach and mode for patients with DCM, and the factors to consider include the clinical symptoms, signs, imaging findings (cervical spinal cord compression factors and responsible segments, degeneration range, cervical curvature and stability), possible surgical complications, operative habits of the surgeons, medical expenses, etc. [ 12 , 13 , 14 ]. In our study, 284 patients with DCM treated with different surgical methods were enrolled.…”

Section: Discussionmentioning

confidence: 99%

The Pre-Operative Duration of Symptoms: The Most Important Predictor of Post-Operative Efficacy in Patients with Degenerative Cervical Myelopathy

Guo

Lin

et al. 2022

Brain Sciences

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Objective. To explore the most important predictors of post-operative efficacy in patients with degenerative cervical myelopathy (DCM). Methods. From January 2013 to January 2019, 284 patients with DCM were enrolled. They were categorized based on the different surgical methods used: single anterior cervical decompression and fusion (ACDF) (n = 80), double ACDF (n = 56), three ACDF (n = 13), anterior cervical corpectomy and fusion (ACCF) (n = 63), anterior cervical hybrid decompression and fusion (ACHDF) (n = 25), laminoplasty (n = 38) and laminectomy and fusion (n = 9). The follow-up time was 2 years. The patients were divided into two groups based on the mJOA recovery rate at the last follow-up: Group A (the excellent improvement group, mJOA recovery rate >50%, n = 213) and Group B (the poor improvement group, mJOA recovery rate ≤50%, n = 71). The evaluated data included age, gender, BMI, duration of symptoms (months), smoking, drinking, number of lesion segments, surgical methods, surgical time, blood loss, the Charlson Comorbidity Index (CCI), CCI classification, imaging parameters (CL, T1S, C2-7SVA, CL (F), T1S (F), C2-7SVA (F), CL (E), T1S (E), C2-7SVA (E), CL (ROM), T1S (ROM) and C2-7SVA (ROM)), maximum spinal cord compression (MSCC), maximum canal compromise (MCC), Transverse area (TA), Transverse area ratio (TAR), compression ratio (CR) and the Coefficient compression ratio (CCR). The visual analog score (VAS), neck disability index (NDI), modified Japanese Orthopedic Association (mJOA) and mJOA recovery rate were used to assess cervical spinal function and quality of life. Results. We found that there was no significant difference in the baseline data among the different surgical groups and that there were only significant differences in the number of lesion segments, C2–7SVA, T1S (F), T1S (ROM), TA, CR, surgical time and blood loss. Therefore, there was comparability of the post-operative recovery among the different surgical groups, and we found that there were significant differences in age, the duration of symptoms, CL and pre-mJOA between Group A and Group B. A binary logistic regression analysis showed that the duration of the symptoms was an independent risk factor for post-operative efficacy in patients with DCM. Meanwhile, when the duration of symptoms was ≥6.5 months, the prognosis of patients was more likely to be poor, and the probability of a poor prognosis increased by 0.196 times for each additional month of symptom duration (p < 0.001, OR = 1.196). Conclusion. For patients with DCM (regardless of the number of lesion segments and the proposed surgical methods), the duration of symptoms was an independent risk factor for the post-operative efficacy. When the duration of symptoms was ≥6.5 months, the prognosis of patients was more likely to be poor, and the probability of a poor prognosis increased by 0.196 times for each additional month of symptom duration (p < 0.001, OR = 1.196).

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“…Several studies have looked at the comparison between ACDF and hybrid procedures. Xu, et al [31] looked at patients (n = 82) with 3-level CSM who underwent ACDF (n = 40) and hybrid decompression (n = 42), and were followed up for a mean of 35.5 months. The authors noted similar improvements in the NDI and JOA scores in both procedures, but ACDF demonstrated superiority to hybrid decompression in terms of less blood loss, shorter operation time, and better postoperative sagittal balance.…”

Section: Hybrid Decompressionmentioning

confidence: 99%

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2021

Neurosurg Cases Rev

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Cervical spondylotic myelopathy (CSM) is a common cause of spinal cord dysfunction. The degenerative disease can cause serious neurological symptoms that can significantly affect the quality of life. The heterogenous presentation of CSM and a lack of a single comprehensive outcome instrument can make the management of suspected CSM very difficult. Despite the advances in surgical techniques to treat CSM, the indications to do surgery remain controversial, particularly in older individuals who commonly present with the disease. There is also debate on the optimal surgical approach to treat CSM, and most neurosurgeons remain unfamiliar with the evaluation tools that drive economic health care as a result of the surgical procedures. Here, the scientific literature was carried out using PubMed with the following keywords: cervical spondylotic myelopathy, anterior, posterior, anterior-posterior, elderly, cost-utility analyses. The bibliographies of these papers were also reviewed to yield additional papers of high significance. The goal of this review is to provide insight in to the surgical outcomes, preoperative management decisions, elderly population, and the cost-effectiveness of the types of surgery in relation to cost per quality-adjusted life year (QALY) gained.

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Anterior Cervical Discectomy and Fusion Versus Hybrid Decompression and Fusion for the Treatment of 3-Level Cervical Spondylotic Myelopathy: A Comparative Analysis of Cervical Sagittal Balance and Outcomes

Cited by 11 publications

References 20 publications

Correction and Maintenance of Cervical Alignment

Correction and Maintenance of Cervical Alignment

The Pre-Operative Duration of Symptoms: The Most Important Predictor of Post-Operative Efficacy in Patients with Degenerative Cervical Myelopathy

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