Li Jing, Wu Yonggui, Liu Hao, Guo Can, Zhang Junqi, Huang Kangkang, Wu Tingkui, Hong Ying, Meng Yang, Ding Chen, Wang Beiyu, Rong Xin
Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
Jincheng People's Hospital, Jincheng, China.
Spine J. 2025 Jun;25(6):1167-1177. doi: 10.1016/j.spinee.2024.12.022. Epub 2024 Dec 18.
Hybrid surgery (HS), which involves both anterior cervical discectomy and fusion (ACDF) and cervical disc replacement (ACDR), is increasingly used to treat multilevel cervical disc degenerative disease, yielding satisfactory clinical outcomes. Early fusion is critical after anterior cervical fusion surgeries, but there are no studies comparing the rate of early fusion of HS with that of ACDF.
The purpose of this study was to compare the rate of early fusion (3-6 months postoperatively) of two-level HS with that of two-level ACDF surgery.
The fusion statuses of consecutive patients who underwent two-level ACDF were compared with those of consecutive patients who underwent HS, which involves both ACDF and ACDR.
The study included 860 patients who underwent two-level ACDF or HS for CDDD. After the patients who did not meet the study criteria were excluded, 376 patients were included (165 males, 211 females).
Radiographic measures included fusion rate of the ACDF level. Self-report measures included visual analog scale (VAS) neck, VAS arm, neck disability index (NDI), satisfaction with the surgery and other symptoms reported by patients during the follow-ups.
Eight hundred sixty patients who underwent two-level ACDF or HS for cervical disc degenerative disease between January 2015 and January 2023 at our hospital were screened. After excluding the patients who did not meet the study criteria, 376 patients were included (165 males, 211 females). The patients who underwent dual-segment ACDF were categorized into the ACDF-ACDF (FF) group (n=205), while those who underwent dual-segment HS were divided into the ACDF-ACDR (FR) group (n=82) and the ACDR-ACDF (RF) group (n=89) on the basis of the relative positions of the segments selected for ACDF and ACDR. The fusion rates of the segments subjected to ACDF and the clinical outcomes, including the neck VAS score, arm VAS score, NDI score, and other complications, were compared among the three groups at 3 months, 6 months, and 1 year postoperatively. Fusion was defined as the formation of a continuous bone bridge in the target fusion area, as observed on three-dimensional computed tomography (CT) images.
The average age of the patients in the FF group was higher than that of the patients in the FR and RF groups (p<.001). At 3 months postoperatively, the fusion rate was 70.7% (58/82) in the FR group, 39.5% (162/410) in the FF group, and 42.7% (78/89) in the RF group (p<.001). At 6 months postoperatively, the fusion rate was 74.6% (306/410) in the FF group, 91.5% (75/82) in the FR group, and 87.6% (78/89) in the RF group (p<.001). At 1 year postoperatively, the fusion rate was 91.9% (377/410) in the FF group, 98.8% (81/82) in the FR group, and 100% (89/89) in the RF group (p=.002). At 3 months postoperatively, the fusion rate was higher in the FR group than in the FF group (70.7% vs 45.4%) (p<.001). At 6 months postoperatively, the fusion rate of the distal segment was higher in the RF group than in the FF group (87.6% vs 66.3%). In the FF group, the fusion rate in the proximal segment was higher than that in the distal segment at 3, 6, and 12 months postoperatively. One year after surgery, 15 segments-3 proximal and 12 distal-in the FF group developed pseudarthrosis. Compared with the other two groups, the FR group had lower neck VAS scores at 3 months postoperatively and a lower rate of dizziness complaints during the 1-year follow-up period. There were no statistically significant differences in the remaining clinical outcomes.
The early fusion rate after two-level HS was higher than that after two-level ACDF. The early fusion rate of two-level HS was higher in the FR group than in the RF group. For two-level ACDF, the early fusion rate was higher in the proximal segment than in the distal segment. Additional biomechanical studies are needed to explore the biomechanical differences in fusion levels between HS and multilevel ACDF.
混合手术（HS），即同时进行颈椎前路椎间盘切除融合术（ACDF）和颈椎间盘置换术（ACDR），越来越多地用于治疗多节段颈椎间盘退变疾病，临床效果令人满意。颈椎前路融合手术后早期融合至关重要，但尚无研究比较HS与ACDF的早期融合率。
本研究旨在比较双节段HS与双节段ACDF手术的早期融合率（术后3 - 6个月）。
将连续接受双节段ACDF患者的融合状态与连续接受HS（包括ACDF和ACDR）患者的融合状态进行比较。
本研究纳入860例因颈椎间盘退变疾病接受双节段ACDF或HS手术的患者。排除不符合研究标准的患者后，纳入376例患者（男性165例，女性211例）。
影像学指标包括ACDF节段融合率。自我报告指标包括视觉模拟量表（VAS）颈部评分、VAS手臂评分、颈部功能障碍指数（NDI）、对手术的满意度以及患者随访期间报告的其他症状。
筛选2015年1月至2023年1月在我院因颈椎间盘退变疾病接受双节段ACDF或HS手术的860例患者。排除不符合研究标准的患者后，纳入376例患者（男性165例，女性211例）。接受双节段ACDF的患者分为ACDF - ACDF（FF）组（n = 205），而接受双节段HS的患者根据ACDF和ACDR所选节段的相对位置分为ACDF - ACDR（FR）组（n = 82）和ACDR - ACDF（RF）组（n = 89）。比较三组术后3个月、6个月和1年时ACDF节段的融合率以及临床结局，包括颈部VAS评分、手臂VAS评分、NDI评分和其他并发症。融合定义为在三维计算机断层扫描（CT）图像上观察到目标融合区域形成连续骨桥。
FF组患者的平均年龄高于FR组和RF组患者（p <.001）。术后3个月时，FR组融合率为70.7%（58/82），FF组为39.5%（162/410），RF组为42.7%（78/89）（p <.001）。术后6个月时，FF组融合率为74.6%（306/410），FR组为91.5%（75/82），RF组为87.6%（7&89）（p <.001）。术后1年时，FF组融合率为91.9%（377/410），FR组为98.8%（81/82），RF组为100%（&9/89）（p =.002）。术后3个月时，FR组融合率高于FF组（70.7%对45.4%）（p <.001）。术后6个月时，RF组远端节段融合率高于FF组（87.6%对66.3%）。在FF组，术后3个月、6个月和12个月时近端节段融合率高于远端节段。术后1年，FF组有15个节段（3个近端和12个远端）发生假关节形成。与其他两组相比，FR组术后3个月颈部VAS评分较低，1年随访期间头晕主诉发生率较低。其余临床结局无统计学显著差异。
双节段HS术后早期融合率高于双节段ACDF。双节段HS的FR组早期融合率高于RF组。对于双节段ACDF，近端节段早期融合率高于远端节段。需要进一步的生物力学研究来探讨HS与多节段ACDF融合节段的生物力学差异。
