133 - Multi-level Fusion versus Hybrid Surgery in Three-level Cervical Disc...

General Session: Cervical-2

Presented by: J-W. Hur - View Audio/Video Presentation (Members Only)


J-W. Hur(1), K-S. Ryu(1), J-S. Kim(1), J-H. Seong(1)

(1) Seoul St. Mary's Hospital, The Catholic University of Korea, Neurosurgery, Spine Center, Seoul, Korea, Republic of


The optimal surgical technique for 3-level cervical disc disease (CDD) remains uncertain. Hybrid surgery, consisting of ADR combined with ACDF, has been reported with favorable results for 2-level cervical disease. In this context, hybrid surgery (2-level ACDF/ADR) for 3-level CDD may be a reasonable alternative to multi-level ACDF to prevent symptomatic ASD. The objective of this study was to compare clinical and radiologic outcomes of 3-level ACDF and hybrid surgery in terms of postoperative adjacent segment degenerations. 18 patients with 3 consecutive levels CDD between C3/4 and C6/7 who underwent hybrid surgery were retrospectively reviewed. Study group were matched paired to 18 patients of 3-level ACDF group based on age, gender and the operated levels. All patients were followed clinically and radiologically for a minimum of 24 months. Radiological measurements including angular range of motion (ROM) of C2-C7 and adjacent segments and cervical lordosis were measured using the Cobb method with PACS software. The radiological evidence of adjacent level changes including new osteophyte formation, narrowing of disc space, end-plate sclerosis and anterior longitudinal ligament (ALL) calcification was assessed. Both groups showed significant improvement in NDI and VAS scores postoperatively and continued improvements were observed in both groups until 2 years. Although no significant differences in NDI scores existed between 2 groups, hybrid group experiences a trend towards better results at 12 and 24 months (p=0,001, 0.018 respectively). VAS scores for postoperative neck pain were significantly less in the hybrid group at 6 and 12 months (4.7±1.6 vs 3.3±1.3; p=0.018, 3.5±1.6 vs 2.3±1.7; p=0.045 respectively), but there was no differences at the final follow-up. The cervical motion was significantly limited immediately after surgery and then gradually recovered. The hybrid group showed greater C2-C7 ROM recovery compared to ACDF group at the final follow-up (36.3±7.9° vs 29.5±7.4°; p=0.034). Although, superior adjacent segment ROM for ACDF group was significantly increased from 12 month after the surgery, the hybrid group remained hypo-mobile during the follow-up periods. The ACDF group exhibited hyper-mobility at inferior adjacent segment ROM from 6 month after the surgery; however, the hybrid group showed no difference during the follow-up periods except final follow-up. Significantly increased ROM at inferior adjacent segments was observed in both groups compared with preoperative values at the final follow-up, but the compensatory ROM was less in hybrid group. Significant recovery of cervical lordosis was observed in both group compared with preoperative. But no statistical difference was found between two groups. Adjacent disc space narrowing was observed equally in both groups. New osteophyte formations were found only in ACDF groups (11%. 2/18). In this study, hybrid surgery consisting of 2-level ACDF and ADR was shown to be safe and effective for 3-level CDD. Compared with ACDF, the hybrid surgery exhibited better neck pain improvement, C2-C7 ROM and less impact at adjacent level. The hybrid surgery may be a promising alternative to fusion surgery for 3-level CDD. Longer-term follow-up is warranted.