A 5-year follow-up on sagittal alignment and radiological outcomes of consecutive three-level anterior cervical discectomy and fusion and hybrid surgery

doi:10.3969/j.issn.2095-4344.3769

Abstract

Abstract: BACKGROUND: In the treatment of single- and double-level cervical spondylosis, anterior cervical discectomy and fusion and hybrid surgery can restore local cervical lordosis, and play a role in the overall sequence of the cervical spine, but the role of this conclusion in three-level surgery is still unclear.
OBJECTIVE: To compare sagittal alignment, radiological parameters and clinical outcomes between three-level hybrid surgery and anterior cervical discectomy and fusion on cervical spondylotic myelopathy.
METHODS: Totally 93 patients with three-level cervical spondylotic myelopathy, who were treated in the Pingdingshan First People’s Hospital from February 2007 to September 2013, were enrolled in this study. Among them, 32 patients underwent anterior cervical discectomy and fusion (anterior cervical discectomy and fusion group); 36 patients underwent single-level disc replacement and double-level hybrid surgery (HS1 group); 25 cases underwent double-level disc replacement and single-level hybrid surgery (HS2 group). X-ray films of cervical spine were taken during the follow-up. Sagittal alignment of cervical spine (C2-C7 cervical lordosis, C2-C7 sagittal vertical axis, and T1 slope) and anatomical parameters (range of motion, upper and lower adjacent range of motion, operated-segment lordosis, and adjacent segment degeneration) were analyzed. Neck disability index and Japanese Orthopedic Association score were used to assess clinical outcomes. This study was approved by the Ethics Committee of Pingdingshan First People’s Hospital.
RESULTS AND CONCLUSION: Ninety-three patients were followed up for a mean of (76.4±9.0) months. (1) There was no significant difference in parameter values of cervical sagittal alignment among the three groups in the final follow-up (P > 0.05). There was no significant difference in the value of each parameter among the three groups at the final follow-up compared with the change before the operation (P > 0.05). (2) There was no significant difference in anatomical parameter values of the cervical spine at the final follow-up among the three groups (P > 0.05), and there was no significant difference in the values of the parameters among the three groups at the final follow-up compared with the preoperative changes (P > 0.05). (3) The neck disability index and Japanese Orthopedic Association score at the final follow-up of the three groups were significantly improved compared with preoperatively (P < 0.05), but there was no significant difference among the three groups (P > 0.05). (4) Correlation analysis showed that there was no clear correlation of cervical spine anatomical parameters and neck disability index with Japanese Orthopedic Association score between postoperative and final follow-up. (5) The results showed that for three-level cervical spondylotic myelopathy, anterior cervical discectomy and fusion and hybrid surgery have achieved a clear mid-term and long-term effect, and there is no clear correlation between anatomical parameters and clinical outcomes, so artificial disc prosthesis implantation is not necessary.

Key words: bone, cervical spondylosis, anterior cervical discectomy and fusion, hybrid surgery, cervical sagittal alignment, imaging parameters, clinical efficacy, mid-term and long-term follow-up

CLC Number:

Ma Long, Tan Xiaoxin, Sun Guoshao. A 5-year follow-up on sagittal alignment and radiological outcomes of consecutive three-level anterior cervical discectomy and fusion and hybrid surgery [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(12): 1879-1885.

Figures/Tables 9

References

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