Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
Spine (Phila Pa 1976). 2018 Oct 15;43(20):1418-1425. doi: 10.1097/BRS.0000000000002639.
A retrospective study.
To compare the mid-term outcomes of hybrid surgery (HS) and anterior cervical discectomy and fusion (ACDF) for the treatment of contiguous two-segment cervical degenerative disc diseases.
HS has become one of the most controversial subjects in spine communities, and the comparative studies of HS and ACDF in the mid- and long-term follow-up are rarely reported.
From 2009 to 2012, 42 patients who underwent HS (n = 20) or ACDF (n = 22) surgery for symptomatic contiguous two-level cervical degenerative disc diseases were included. Clinical and radiological records, including Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), Visual Analogue Scale (VAS), local cervical lordosis, and range of motion (ROM), were reviewed retrospectively. Complications were recorded and evaluated.
Mean follow-up was 77.25 and 79.68 months in HS group and ACDF group, respectively (P > 0.05). Both in HS group and ACDF group, significant improvement for the mean JOA, NDI, and VAS scores was found at 2-week postoperation and at the last follow-up (P < 0.05). However, there were no significant differences between the two groups (P > 0.05). At the last follow-up, the range of motion (ROM) of superior adjacent segments in ACDF group was significantly larger than HS group (P < 0.05), while the ROM of C2-C7 was significantly smaller (P < 0.05). In the HS group, two (10%) sagittal wedge deformities, one (5%) heterotopic ossification, and one (5%) anterior migration of the Byran disc prosthesis were found. No symptomatic adjacent segment degeneration occurred in two groups.
HS appears to be an acceptable option in the management of contiguous two-segment cervical degenerative disc diseases. It yielded similar mid-term clinical improvement to ACDF, and demonstrated better preservation of cervical ROM. The incidence of postoperative sagittal wedge deformity was low; however, it can significantly reduce the cervical lordosis.
回顾性研究。
比较杂交手术（HS）与前路颈椎间盘切除融合术（ACDF）治疗连续两节段颈椎退行性椎间盘疾病的中期疗效。
HS 已成为脊柱领域最具争议的话题之一，而关于 HS 与 ACDF 在中、长期随访中的比较研究则很少报道。
2009 年至 2012 年，我们共纳入了 42 例因连续两节段颈椎退行性椎间盘疾病而接受 HS（n=20）或 ACDF（n=22）手术治疗的患者。回顾性分析了包括日本矫形协会（JOA）评分、颈残障指数（NDI）、视觉模拟评分（VAS）、局部颈椎前凸角和活动度（ROM）在内的临床和影像学资料。记录并评估了并发症。
HS 组和 ACDF 组的平均随访时间分别为 77.25 和 79.68 个月（P＞0.05）。HS 组和 ACDF 组在术后 2 周和末次随访时 JOA、NDI 和 VAS 评分的均值均显著改善（P＜0.05），但两组间差异无统计学意义（P＞0.05）。末次随访时，ACDF 组上相邻节段活动度（ROM）明显大于 HS 组（P＜0.05），而 C2-C7 的 ROM 明显较小（P＜0.05）。HS 组有 2 例（10%）出现矢状面楔形畸形、1 例（5%）发生异位骨化、1 例（5%） Bryan 椎间盘假体向前移位。两组均未发生症状性邻近节段退变。
HS 似乎是治疗连续两节段颈椎退行性椎间盘疾病的一种可接受的选择。它在中短期临床改善方面与 ACDF 相似，但能更好地保留颈椎 ROM。术后矢状面楔形畸形的发生率较低，但会显著降低颈椎前凸角。
4 级。
