Hybrid construct for two levels disc disease in lumbar spine

Abstract

Prospective study. To study the validity of Hybrid construction (Anterior Lumbar Interbody Fusion) ALIF at one level and total disc arthroplasty (TDA) at adjacent, for two levels disc disease in lumbar spine as surgical strategy. With growing evidence that fusion constructs in the treatment of degenerative disc disease (DDD) may alter sagittal balance and contribute to undesirable complications in the long-term, total disc arthroplasty (TDA) slowly becomes an accepted treatment option for a selected group of patients. Despite encouraging early and intermediate term results of single-level total disc arthroplasty reported in the literature, there is growing evidence that two-level arthroplasty does not fare as well. Hybrid fusion is an attempt to address two-level DDD by combining the advantages of a single-level ALIF with those of a single-level arthroplasty. 42 patients (25 females and 17 males) underwent Hybrid fusion and had a median followup of 26.3 months. The primary functional outcomes were assessed before and after surgery with Oswestry Disability Index and the visual analogue score of the back and legs. Patients were divided into four groups according to the percentage improvement between preop and postop ODI scores. A total of 42 patients underwent a hybrid fusion as follows: 35 L5-S1 ALIF/L4-5 prosthesis, 3 L4-5 ALIF/L3-4 prosthesis, 2 L5-S1 ALIF/L4-5 prosthesis/L3-4 prosthesis, 1 L5-S1 prosthesis/L4-5 ALIF, and 1 L5-S1 ALIF/L4-5 ALIF/L3-4 prosthesis. At 2-years clinical outcomes, mean reduction in ODI is 24.9 points (53.0% improvement compared to preop ODI). The visual analogue score for the back is 64.6% improvement. At 2-year clinical outcomes, Hybrid fusion is a viable surgical alternative for the treatment of two-level DDD in comparison with two-level TDA and with two-level fusion.

Two-level lumbar total disc replacement: Functional outcomes and segmental motion after 4 years

“…4), but the small number of patients in some of these studies tempers the interpretation of these results. Only one study provides similar information for hybrid constructs [10]. Despite the use of different constructs, the ODI and lumbar VAS were decreased by 53% and 65%, respectively, after 2 years of follow-up, which was comparable to the results of the current study (Fig.…”

“…However, TDR has been shown to be non-inferior to spinal fusion for the treatment of two-level degenerative disc disease (DDD), while improving mobility and functional recovery in the short term [9]. The alternative is to use a hybrid construct [10,11] that combines fusion and arthroplasty, with preservation of segmental motion being the theoretical advantage of the latter.…”

Prothèses discales lombaires sur 2 étages : résultats fonctionnels et étude des mobilités intra-prothétiques et à 4ans de recul

“…ODI/100, comparaisons PTD multiniveaux (2 à 3 niveaux). Seule l'étude d'Aunoble et al [10] permet d'établir une comparaison avec les montages hybrides. Malgré des montages hétérogènes, l'ODI et l'EVA lombaire y sont respectivement améliorés de 53 et 65 % à 2 ans de recul, avec des résultats comparables à ceux de la série (Fig.…”

“…La prothèse totale de disque (PTD) sur 2 niveaux a cependant également fait la preuve de sa non infériorité sur l'arthrodèse 2 étages avec un gain en termes de mobilité et de qualité de récupération fonctionnelle à court terme [9]. L'alternative est la réalisation d'un montage hybride [10,11] associant arthrodèse et prothèse, l'avantage théorique de l'arthroplastie restant la conservation des mobilités.…”

The Michel Benoist and Robert Mulholland yearly European Spine Journal Review: a survey of the “surgical and research” articles in the European Spine Journal, 2010

“…The paper by Aunoble et al [6] is a cohort study of 42 patients who had what is termed a ''hybrid construction'', a fusion at L5/S1 and a disc replacement at L4/5. The results were good, and the authors recommend it as an alternative to a two-level disc replacement or two-level fusions, to avoid problems of sagittal balance and adjacent segment degeneration.…”