Concurrent Use of Lumbar Total Disc Arthroplasty and Anterior Lumbar Interbody Fusion: The Lumbar Hybrid Procedure for the Treatment of Multilevel Symptomatic Degenerative Disc Disease

Abstract

Study Design.A prospective study.Objective.The aim of this study was to evaluate clinical and patient outcomes post combined total disc arthroplasty (TDA) and anterior lumbar interbody fusion (ALIF), known as hybrid surgery for the treatment of multilevel symptomatic degenerative disc disease (DDD).Summary of Background Data.Class I studies comparing the treatment of one-level lumbar DDD with TDA and ALIF have confirmed the effectiveness of those treatments through clinical and patient outcomes. Although the success of single-level disease is well documented, the evidence relating to the treatment of multilevel DDD with these modalities is emerging. With the evolution of the TDA technology, a combined approach to multilevel disease has developed in the form of the hybrid procedure.Methods.A total of 617 patients underwent hybrid surgery for chronic back pain between July 1998 and February 2012. Visual Analog Pain Scale for the back and leg were recorded along with the Oswestry Disability Index and Roland Morris Disability Questionnaire.Results.Both statistically and clinically significant (p < 0.005) reductions were seen in back and leg pain, which were sustained for at least 8 years postsurgery. In addition, significant improvements (P < 0.001) in self-rated disability and function were also maintained for at least 8 years. Patient satisfaction was rated as good or excellent in >90% of cases.Conclusion.The results of this research indicate that improvements in both back and leg pain and function can be achieved using the hybrid lumbar reconstructive technique.Level of Evidence: 4

Comparison of Mid- to Long-term Follow-up of Patient-reported Outcomes Measures After Single-level Lumbar Total Disc Arthroplasty, Multi-level Lumbar Total Disc Arthroplasty, and the Lumbar Hybrid Procedure for the Treatment of Degenerative Disc Disease

“…Options to treat single-level DDD operatively include total disc arthroplasty (TDA) or anterior lumbar interbody fusion (ALIF). TDA acts as a dynamic motion segment stabilizer, and has been shown to reduce back pain, improve functional outcomes, and reduce clinical and radiological adjacent segment pathology (CASP/RASP) 9 . ALIF acts as a static motion segment stabilizer with similar improvement in clinical outcomes 10,11 .…”

“…Other surgical preferences for treating DDD include transforaminal or posterior lumbar interbody fusion, and lateral based techniques. There is considerable evidence on the benefits of TDA 10,15 ALIF 22,23 and hybrid 9,21,24,25 constructs in treating symptomatic DDD with comparison studies showing similar clinical outcomes 11,17,23,26–28 . However, there are few long-term studies comparing these procedures with each other.…”

The Role of 3D Exoscope Systems in Neurosurgery: An Optical Innovation

“…This is commonly performed for patients suffering from lower back pain as a result of degenerative disc disease (DDD). DDD represents the most common physical disability in the United States, with the annual national cost of care reaching over 90 billion dollars [28]. Back and neck pain is commonly attributed to DDD; however, spinal stenosis, disc herniation, and degenerative spondylolisthesis are also common comorbidities of this pathology [28][29][30].…”

“…DDD represents the most common physical disability in the United States, with the annual national cost of care reaching over 90 billion dollars [28]. Back and neck pain is commonly attributed to DDD; however, spinal stenosis, disc herniation, and degenerative spondylolisthesis are also common comorbidities of this pathology [28][29][30]. Specifically, DDD is a reference to the degradation of the intervertebral disc in between the vertebral bodies [31,32].…”

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“…Similarly, Scott-Young et al prospectively followed 617 patients undergoing hybrid surgery for chronic back pain and found a clinically significant reduction in back and leg pain throughout the months followed for up to eight years. The mean ODI and VAS score difference is above minimally meaningful clinically important difference = 10, suggesting meaningfulness [ 13 ].…”