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?

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 degrees ) 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.

Zero-P: a new zero-profile cage-plate device for single and multilevel ACDF. A single Institution series with four years maximum follow-up and review of the literature on zero-profile devices

“…Interestingly, in the selected cohort of patients herein analyzed only 4 patients underwent such treatment (2 double level and 2 three levels) and follow-up X-rays evaluation did not show differences in fusion rate between the two different devices used in the same patient and also in comparison to other patients treated with Zero-P only devices. Yet, combination of different devices in a hybrid construct in the cervical spine can be a safe and effective solution, as we also reported in the association of arthrodesis and arthroplasty [4].…”

The effect of multilevel anterior cervical fusion on neck motion

“…Anterior cervical decompression and fusion (ACDF) has been a successful and reliable procedure for treatment of cervical degenerative disorders [8][9][10][11][12]. It restores cervical lordosis better and directly decompresses the spinal cord by removing the offending soft or hard discs [13].…”

A case of cervical metastases in a patient with preexisting cervical disc replacement and fusion after 2-year symptom-free interval: when do we need interdisciplinary diagnostics?

“…This applies likewise to disc replacement in combination with fusion 11,12. Yet, postoperative cervicobrachialgia is not uncommon 5,13,14.…”