nach oben

European Spine Journal

Erschienen in:

29.03.2024 | Original Article

Could the different surgical goals of fusion and non-fusion also be achieved in combination within the same patient? Clinical and radiological outcome of hybrid cervical spine surgery

verfasst von: Franziska C. Heider, Maria Kamenova, Lorenz Wanke-Jellinek, Christoph J. Siepe, Christoph Mehren

Erschienen in: European Spine Journal | Ausgabe 6/2024

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Hybrid cervical spine surgery (HS) is a novel surgical strategy wherein an artificial disc replacement is done with a cervical fusion nearby with a stand-alone titanium cage to combine the advantages in both procedures. The aim of this study was to evaluate interactions of these devices within the same patient, and to analyze, if the different goal of each implant is accomplished.

Methods

Thirty-six patients were treated surgically within a non-randomized retrospective study framework with HS. Patients were examined preoperatively followed by clinical and radiological examination at least one year postoperative. Clinical outcome was detected with NDI, VAS arm/neck, pain self-assessment questionnaires and subjective patient satisfaction. Radiological assessments included RoM, segmental lordosis, cervical lordosis of C2-C7, subsidence, ap-migration and heterotopic ossifications (HO) at the cTDR levels.

Results

Statistically significant improvement of all clinical scores was observed (NDI 37.5 to 5.76; VASarm 6.41 to 0.69; VASneck 6.78 to 1.48). Adequate RoM was achieved at cTDR levels. RoM in the ACDF levels was reduced statistically significant (p < 0.001), and solid fusion (> 2°) was achieved in all evaluated fusion level. Global lordosis (C2-C7) increased statistically significant (2.4° to 8.1°). Subsidence and HO at the cTDR levels did not occur.

Conclusions

HS results in preservation of the segmental motion in the cTDR and fast and solid fusion in the cage cohort simultaneously. Patient safety was proven. In carefully selected cases, HS is a safe and viable treatment option by choosing the right “philosophy” level per level.

Cloward RB (1958) The anterior approach for removal of ruptured cervical discs. J Neurosurg 15(6):602–617. https://doi.org/10.3171/jns.1958.15.6.0602CrossRefPubMed

Smith GW, Robinson RA (1958) The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am 40-A(3):607–624

Mehren C, Heider F, Siepe CJ et al (2017) Clinical and radiological outcome at 10 years of follow-up after total cervical disc replacement. Eur Spine J 26(9):2441–2449. https://doi.org/10.1007/s00586-017-5204-6CrossRefPubMed

Delamarter RB, Zigler J (2013) Five-years reoperation rates, cervical total disc replacement versus fusion, results of a prospective randomized clinical trial. Spine (Phila Pa 1976) 38(9):711–717. https://doi.org/10.1097/BRS.0b013e3182797592.

Loumeau TP, Darden BV, Kesman TJ et al (2016) A RCT comparing 7-year clinical outcomes of one level symptomatic cervical disc disease (SCDD) following ProDisc-C total disc arthroplasty (TDA) versus anterior cervical discectomy and fusion (ACDF). Eur Spine J 25(7):2263–2270. https://doi.org/10.1007/s00586-016-4431-6CrossRefPubMed

Skeppholm M, Lindgren L, Henriques T et al (2015) The Discover artifical disc replacement versus fusion in cervical radiculopathy – a randomized controlled outcome trial with 2-year follow-up. Spine J 15(6):1284–1294. https://doi.org/10.1016/j.spinee.2015.02.039CrossRefPubMed

Eck JC, Humphreys SC, Lim T-H, et al (2002) Biomechanical study on the effect of cervical spine fusion on adjacent-level intradiscal pressure and segmental motion. Spine (Phila Pa 1976) 27(22): 2432–2434. https://doi.org/10.1097/00007632-200211150-00003

Wigfield C, Gill S, Nelson R et al (2002) Influence of an artificial cervical joint compared with fusion on adjacent-level motion in the treatment of degenerative cervical disc disease. J Neurosurg 96(1 Suppl):17–21. https://doi.org/10.3171/spi.2002.96.1.0017CrossRefPubMed

Cho D-Y, Liau W-R, Lee W-Y, et al (2002) Preliminary experience using a polyetheretherketone (PEEK) cage in the treatment of cervical disc disease. Neurosurgery 51(6):1343–1349; discussion 1349–1350

10.

Hilibrand AS, Robbins M (2004) Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J 4(6 Suppl):190S-194S. https://doi.org/10.1016/j.spinee.2004.07.007CrossRefPubMed

11.

Goffin J, Geusens E, Vantomme N, et al (2004) Long-Term Follow-Up after interbody fusion of the cervical spine. J Spinal Disord Tech 17(2):79–85. https://doi.org/10.1097/00024720-200404000-0000-1

12.

Hey HWD, Hong CC, Long AS et al (2013) Is hybrid surgery of the cervical spine a good balance between fusion and arthroplasty? Pilot results from a single surgeon series. Eur Spine J 22(1):116–122. https://doi.org/10.1007/s00586-012-2486-6CrossRefPubMed

13.

Lu VM, Zhang L, Scherman DB et al (2017) Treating multi-level cervical disc disease with hybrid surgery compared to anterior cervical discectomy and fusion: a systematic review and meta-analysis. Eur Spine J 26(1):285–287. https://doi.org/10.1007/s00586-016-4820-xCrossRef

14.

Mehren C, Suchomel P, Grochulla F, et al (2006) Heterotopic ossification in total cervical artificial disc replacement. Spine (Phila Pa 1976) 31(24):2802–2806. https://doi.org/10.1097/01.brs.0000245852

15.

Pehlivanoglu T, Wuertz-Kozak K, Heider F, et al (2019) Clinical and radiographic outcome of patients with cervical spondylotic myelopathy undergoing total disc replacement. Spine (Phila Pa 1976) 44(20):1403–1411. https://doi.org/10.1097/BRS.0000000000003079

16.

Mehren C, Wuertz-Kozak K, Sauer D, et al (2019) Implant design and the anchoring mechanism influence the incidence of heterotopic ossification in cervical total disc replacement at 2-year Follow-up. Spine (Phila Pa 1976) 44(21):1471–1480. https://doi.org/10.1097/BRS.0000000000003098

17.

Barbagallo GMV, Assietti R, Corbino L, et al (2009) 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? Eur Spine J 18 Suppl1(Suppl1):29–39. https://doi.org/10.1007/s00586-009-0978-9

18.

Schulze M, Trautwein F, Vordemvenne T et al (2011) A method to perform spinal motion analysis from functional X-ray images. J Biomech 44(9):1740–1746. https://doi.org/10.1016/j.jbiomech.2011.03.040CrossRefPubMed

19.

Arts M, Torensma B, Wolfs J (2020) Porous titanium cervical interbody fusion device in the treatment of degenerative cervical radiculopathy; 1-year results of a prospective controlled trial. Spine J 20(7):1065–1072. https://doi.org/10.1016/j.spinee.2020.03.008CrossRefPubMed

20.

Peppers TA, Bullard DE, Vanichkachorn JS et al (2017) Prospective clinical and radiographic evaluation of an allogenic bone matrix containing stem cells (Trinity Evolution® Viable Cellular Bone Matrix) in patients undergoing two-level anterior cervical discectomy and fusion. J Orthop Surg Res 12(1):67. https://doi.org/10.1186/s13018-017-0564-5CrossRefPubMedPubMedCentral

21.

Noordhoek I, Koning MT, Jacobs WCH et al (2018) Incidence and clinical relevance of cage subsidence in anterior cervical discectomy and fusion: a systematic review. Acta Neurochir (Wien) 160(4):873–880. https://doi.org/10.1007/s00701-018-3490-3CrossRefPubMed

22.

Ament JD, Vokshoor A, Yee R et al (2022) A systematic review and meta-analysis of silicon nitride and biomaterial modulus as it relates to subsidence risk in spinal fusion surgery. N Am Spine Soc J 9(12):100168. https://doi.org/10.1016/j.xnsj.2022.100168CrossRef

23.

Arts MP, Wolfs JFC, Corbin TP (2017) Porous silicon nitride spacers versus PEEK cages for anterior cervical discectomy and fusion: clinical and radiological results of a single-blinded randomizes controlled trial. Eur Spine J 26:2372–2379. https://doi.org/10.1007/s00586-017-5079-6CrossRefPubMed

24.

Bohlmann HH, Emery SE, Goodfellow DB, et al (1993) Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients. J Bone Joint Surg Am 75(9):1298–1307. https://doi.org/10.2106/00004623-199309000-00005

25.

DiAngelo DJ, Foley KT, Vossel KA, et al (2000) Anterior cervical plating reverses load transfer through multilevel strut-grafts. Spine (Phila Pa 1976) 25(7):783–795. https://doi.org/10.1097/00007632-200004010-00005

26.

DiAngelo DJ, Robertson JT, Metcal NH et al (2003) Biomechanical testing of an artificial cervical joint and an anterior cervical plate. J Spinal Disord Tech 16(4):314–323. https://doi.org/10.1097/00024720-2003080000-00002CrossRefPubMed

27.

Lee S-B, Cho K-S, Kim J-Y et al (2012) Hybrid surgery of multilevel cervical degenerative disc disease: review of the literature and clinical results. J Korean Neurosurg Soc 52(5):452–458. https://doi.org/10.3340/jkns.2012.52.5.452CrossRefPubMedPubMedCentral

28.

Boddapati V, Lee NJ, Mathew J et al (2020) Hybrid anterior cervical discectomy and fusion and cervical disc arthroplasty: an analysis of short-term complications, reoperations, and readmissions. Global Spine J 11(8):1183–1189. https://doi.org/10.1172/2192568220941453CrossRefPubMedPubMedCentral

29.

Zhang J, Meng F, Ding Y, et al (2020) Comprehensive analysis of hybrid surgery and anterior cervical discectomy and fusion in cervical diseases: a meta-analysis. Medicine 99(5):e19055. https://doi.org/10.1097/MD.0000000000019055

30.

MacDowall A, Skeppholm M, Robinson Y, et al (2018) Validation of the visual analog scale in the cervical spine. J Neurosurg Spine 28(3):227–235. https://doi.org/10.3171/2017.5.SPINE1732

31.

Parker SL, Godil SS, Shau DN (2013) Assessment of the minimum clinically important difference in pain, disability, and quality of life after anterior cervical discectomy and fusion: clinical article. J Neurosurg Spine 18(2):154–160. https://doi.org/10.3171/2012.10.SPINE12312CrossRefPubMed

32.

Shin DA, Yi S, Yoon DH, et al (2009) Artificial disc replacement combined with fusion versus two-level fusion in cervical two-level disc disease. Spine (Phila Pa 1976) 34(11):1153–1159 (discussion 1160–1161). https://doi.org/10.1097/BRS.0b013e31819c9d39

33.

Johnson JP, Lauryssen C, Cambren HO et al (2004) Sagittal alignement and the Bryan cervical artificial disc. Neurosurg Focus 17(6):E14. https://doi.org/10.3171/foc.2004.17.6.14CrossRefPubMed

34.

Di Martino A, Papalia R, Albo E, et al (2015) Cervical spine alignement in disc arthroplasty: should we change our perspective? Eur Spine J 24(Suppl 7):810–825. https://doi.org/10.1007/s00586-015-4258-6

35.

Mayer F, Heider F, Haasters F, et al (2022) Radiological and clinical outcomes after anterior cervical discectomy and fusion (ACDF) with an innovative 3D printed cellular titanium cage filled with vertebral bone marrow. Biomed Res Int 6339910. https://doi.org/10.1155/2022/6339910. eCollection 2022

36.

Mehren C, Heider F, Sauer D, et al (2019) Clinical and radiological outcome of a new total cervical disc replacement design. Spine (Phila Pa 1976) 44(4):E202–E210. https://doi.org/10.1097/BRS.0000000000002799

37.

Liu Y, Qi M, Chen H et al (2012) Comparative analysis of complications of different reconstructive techniques following anterior decompression for multilevel cervical spondylotic myelopathy. Eur Spine J 21:2428–2435. https://doi.org/10.1007/s00586-012-2323-yCrossRefPubMedPubMedCentral

Titel: Could the different surgical goals of fusion and non-fusion also be achieved in combination within the same patient? Clinical and radiological outcome of hybrid cervical spine surgery
verfasst von: Franziska C. Heider
Maria Kamenova
Lorenz Wanke-Jellinek
Christoph J. Siepe
Christoph Mehren
Publikationsdatum: 29.03.2024
Verlag: Springer Berlin Heidelberg
Erschienen in: European Spine Journal / Ausgabe 6/2024
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-024-08204-x

Bracing in severe skeletally immature adolescent idiopathic scoliosis: does a holding strategy change the surgical plan?

Open Access
Original Article

Rib index is a strong surrogate of scoliometric reading in idiopathic scoliosis

Original Article

A novel MRI-based Cervical-Endplate Bone Quality score independently predicts cage subsidence after Anterior Cervical Discectomy and Fusion

Original Article

Risk factors for neurophysiological events related to intraoperative halo-femoral traction in spinal deformity surgery

Open Access
Original Article

Answer to the letter to the editor of A. Kleebayoon, et al. concerning “ChatGPT versus NASS clinical guidelines for degenerative spondylolisthesis: a comparative analysis” by Ahmed W, et al. (Eur Spine J [2024]: doi: 10.1007/s00586-024-08198-6)

Author's Reply

Tip of the iceberg: unveiling the impact on back disorders from cumulative physical job exposure and evaluating bias from the healthy worker effect using a nationwide longitudinal cohort study

Open Access
Original Article

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie erweitert durch Fallbeispiele, Videos und Abbildungen. Zur Fortbildung und Wissenserweiterung, verfasst und geprüft von Expertinnen und Experten der Gesellschaft für Arthroskopie und Gelenkchirurgie (AGA).

Jetzt entdecken!

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Nackenschmerzen nach Bandscheibenvorfall: Muskeltraining hilft!

15.01.2025
Nackenschmerzen
Nachrichten

Bei hartnäckigen Schmerzen aufgrund einer zervikalen Radikulopathie schlägt ein Team der Universität Istanbul vor, lokale Steroidinjektionen mit einem speziellen Trainingsprogramm zur Stabilisierung der Nackenmuskulatur zu kombinieren.

Die elektronische Patientenakte kommt: Das sollten Sie jetzt wissen

12.01.2025
Elektronische Patientenakte
Nachrichten

Am 15. Januar geht die „ePA für alle“ zunächst in den Modellregionen an den Start. Doch schon bald soll sie in allen Praxen zum Einsatz kommen. Was ist jetzt zu tun? Was müssen Sie wissen? Wir geben in einem FAQ Antworten auf 21 Fragen.

Was sich Menschen mit Frozen Shoulder wünschen

10.01.2025
Schultersteife
Nachrichten

Die Capsulitis adhaesiva des Glenohumeralgelenks, auch als Frozen Shoulder bezeichnet, belastet die Betroffenen weit über die körperlichen Beschwerden hinaus, wie eine italienische Studie ergeben hat.

Restriktive Sauerstoffgabe ohne Vorteil bei schwerem Trauma

09.01.2025
Traumatologische Notfallmedizin
Nachrichten

Ob schwer verletzte Personen besser restriktiv oder liberal mit Sauerstoff versorgt werden sollten, hat die Arbeitsgruppe der TRAUMOX2-Studie untersucht – mit klarem Ergebnis.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Could the different surgical goals of fusion and non-fusion also be achieved in combination within the same patient? Clinical and radiological outcome of hybrid cervical spine surgery