Clinical and radiological features of hybrid surgery in multilevel cervical degenerative disc disease

Purpose: Although several studies have established the safety and efficacy of cervical disc arthroplasty (CDA) as compared to anterior cervical discectomy and fusion (ACDF), few studies have investigated the role of hybrid surgery (HS) that incorporates ACDF and CDA techniques in multilevel cervical degenerative disc disease (MLCDDD). Methods: This prospective study enrolled patients with MLCDDD who underwent HS. Twenty consecutive patients who underwent HS were compared with patients who underwent ACDF and CDA at the same level of surgery. Patients were followed up for more than 2 years. Intraoperative parameters, clinical features and outcome scores were recorded. Radiological assessments included overall range of motion (ROM), disc height (DHI), and changes in adjacent disc spaces. Results: Duration of surgery was significantly shorter for ACDF compared with HS and CDA (P < 0.05). The VAS, SF-36, JOA, and NDI scores improved significantly after surgery in all the patients without significant differences among the groups. Cervical ROM increased significantly in CDA and HS groups as compared with ACDF-treated patients (P < 0.05). The mean DHI at the treated level was significantly restored after surgery in all the groups. The HS group returned to work faster (30 days) when compared with both ACDF (62 days) and CDA (65 days) (P < 0.05). Conclusion: HS is an effective, reliable, and safe procedure for the treatment MLCDDD. Such a surgical construct is comparable to ACDF and CDA in terms of safety and feasibility. However, large, randomized controlled trials are warranted.