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Published in: European Spine Journal 1/2009

01-06-2009 | Original Article

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?

Authors: Giuseppe M. V. Barbagallo, Roberto Assietti, Leonardo Corbino, Giuseppe Olindo, Pietro V. Foti, Vittorio Russo, Vincenzo Albanese

Published in: European Spine Journal | Special Issue 1/2009

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Abstract

We report the clinical and radiological results on the safety and efficacy of an unusual surgical strategy coupling anterior cervical discectomy and fusion and total disc replacement in a single-stage procedure, in patients with symptomatic, multilevel cervical degenerative disc disease (DDD). The proposed hybrid, single-stage, fusion–nonfusion technique aims either at restoring or maintaining motion where appropriate or favouring bony fusion when indicated by degenerative changes. Twenty-four patients (mean age 46.7 years) with symptomatic, multilevel DDD, either soft disc hernia or different stage spondylosis per single level, with predominant anterior myeloradicular compression and absence of severe alterations of cervical spine sagittal alignment, have been operated using such hybrid technique. Fifteen patients underwent a two-level surgery, seven patients received a three-level surgery and two a four-level procedure, for a total of 59 implanted devices (27 disc prostheses and 32 cages). Follow-up ranged between 12 and 40 months (mean 23.8 months). In all but one patient clinical follow-up (neurological examination, Nurick scale, NDI, SF-36) demonstrated significant improvement; radiological evaluation showed functioning disc prostheses (total range of motion 3–15°) and fusion through cages. None of the patients needed revision surgery for persisting or recurring symptoms, procedure-related complications or devices dislocations. To the authors’ best knowledge, this is the first study with the longest available follow-up describing a different concept in the management of cervical multilevel DDD. Although larger series with longer follow-up are needed, in selected cases of symptomatic multilevel DDD, the proposed surgical strategy appears to be a safe and reliable application of combined arthroplasty and arthrodesis during a single surgical procedure.
Literature
1.
go back to reference Bertagnoli R, Yue JJ, Pfeiffer F et al (2005) Early results after ProDisc-C cervical disc replacement. J Neurosurg Spine 2:403–410PubMedCrossRef Bertagnoli R, Yue JJ, Pfeiffer F et al (2005) Early results after ProDisc-C cervical disc replacement. J Neurosurg Spine 2:403–410PubMedCrossRef
2.
go back to reference Duggal N, Pickett GE, Mitsis DK et al (2004) Early clinical and biomechanical results following cervical arthroplasty. Neurosurg Focus 17(3):62–68CrossRef Duggal N, Pickett GE, Mitsis DK et al (2004) Early clinical and biomechanical results following cervical arthroplasty. Neurosurg Focus 17(3):62–68CrossRef
3.
go back to reference Mummaneni PV, Burkus JK, Haid RW et al (2007) Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion: a randomized controlled clinical trial. J Neurosurg Spine 6(3):198–209PubMedCrossRef Mummaneni PV, Burkus JK, Haid RW et al (2007) Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion: a randomized controlled clinical trial. J Neurosurg Spine 6(3):198–209PubMedCrossRef
4.
go back to reference Pickett GE, Mitsis DK, Sekhon LH et al (2004) Effects of a cervical disc prosthesis on segmental and cervical spine alignment. Neurosurg Focus 17(3):30–35CrossRef Pickett GE, Mitsis DK, Sekhon LH et al (2004) Effects of a cervical disc prosthesis on segmental and cervical spine alignment. Neurosurg Focus 17(3):30–35CrossRef
5.
go back to reference Porchet F, Metcalf NH (2004) Clinical outcomes with the Prestige II cervical disc: preliminare results from a prospective randomized clinical trial. Neurosurg Focus 17(3):36–43CrossRef Porchet F, Metcalf NH (2004) Clinical outcomes with the Prestige II cervical disc: preliminare results from a prospective randomized clinical trial. Neurosurg Focus 17(3):36–43CrossRef
6.
go back to reference Robertson JT, Metcalf NH (2004) Long-term outcome after implantation of the Prestige I disc in an end-stage indication: 4-year results from a pilot study. Neurosurg Focus 17(3):69–71CrossRef Robertson JT, Metcalf NH (2004) Long-term outcome after implantation of the Prestige I disc in an end-stage indication: 4-year results from a pilot study. Neurosurg Focus 17(3):69–71CrossRef
7.
go back to reference Bryan VE (2002) Cervical motion segment replacement. Eur Spine J 11(Suppl 2):S92–S97PubMed Bryan VE (2002) Cervical motion segment replacement. Eur Spine J 11(Suppl 2):S92–S97PubMed
8.
go back to reference Lafuente J, Casey AT, Petzold A et al (2005) The Bryan cervical disc prosthesis a san alternative to arthrodesis in the treatment of cervical spondylosis. J Bone Joint Surg Br 87(4):508–512PubMedCrossRef Lafuente J, Casey AT, Petzold A et al (2005) The Bryan cervical disc prosthesis a san alternative to arthrodesis in the treatment of cervical spondylosis. J Bone Joint Surg Br 87(4):508–512PubMedCrossRef
9.
go back to reference Pimenta L, McAfee PC, Cappuccino A et al (2007) Superiority of multilevel cervical arthroplasty outcomes versus single-level outcomes: 229 consecutive PCM prostheses. Spine 32(12):1337–1344PubMedCrossRef Pimenta L, McAfee PC, Cappuccino A et al (2007) Superiority of multilevel cervical arthroplasty outcomes versus single-level outcomes: 229 consecutive PCM prostheses. Spine 32(12):1337–1344PubMedCrossRef
10.
go back to reference Sekhon LHS (2004) Cervical arthroplasty in the management of spondylotic myelopathy: 18-month results. Neurosurg Focus 17(3):55–61CrossRef Sekhon LHS (2004) Cervical arthroplasty in the management of spondylotic myelopathy: 18-month results. Neurosurg Focus 17(3):55–61CrossRef
11.
go back to reference Sekhon LHS (2004) Two-level artificial disc placement for spondylotic cervical myelopathy. J Clin Neurosci 11(4):412–415PubMedCrossRef Sekhon LHS (2004) Two-level artificial disc placement for spondylotic cervical myelopathy. J Clin Neurosci 11(4):412–415PubMedCrossRef
12.
go back to reference Kaiser MG, Haid RW Jr, Subach BR et al (2002) Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft. Neurosurgery 50:229–238PubMedCrossRef Kaiser MG, Haid RW Jr, Subach BR et al (2002) Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft. Neurosurgery 50:229–238PubMedCrossRef
13.
go back to reference Matz PG, Pritchard PR, Hadley MN (2007) Anterior cervical approach for the treatment of cervical myelopathy. Neurosurgery 60(Suppl):64–70CrossRef Matz PG, Pritchard PR, Hadley MN (2007) Anterior cervical approach for the treatment of cervical myelopathy. Neurosurgery 60(Suppl):64–70CrossRef
14.
go back to reference Ashkenazi E, Smorgick Y, Rand N et al (2005) Anterior decompression combined with corpectomies and discectomies in the management of multilevel cervical myelopathy: a hybrid decompression and fixation technique. J Neurosurg Spine 3:205–209PubMedCrossRef Ashkenazi E, Smorgick Y, Rand N et al (2005) Anterior decompression combined with corpectomies and discectomies in the management of multilevel cervical myelopathy: a hybrid decompression and fixation technique. J Neurosurg Spine 3:205–209PubMedCrossRef
15.
go back to reference Wiggins GC, Shaffrey CI (2007) Dorsal surgery for myelopathy and myeloradiculopathy. Neurosurgery 60(Suppl):71–81CrossRef Wiggins GC, Shaffrey CI (2007) Dorsal surgery for myelopathy and myeloradiculopathy. Neurosurgery 60(Suppl):71–81CrossRef
16.
go back to reference DiAngelo DJ, Robertson JT, Metcalf NH et al (2003) Biomechanical testing of an artificial cervical joint and an anterior cervical plate. J Spinal Disord Tech 16:314–323PubMed DiAngelo DJ, Robertson JT, Metcalf NH et al (2003) Biomechanical testing of an artificial cervical joint and an anterior cervical plate. J Spinal Disord Tech 16:314–323PubMed
17.
go back to reference DiAngelo DJ, Foley KT, Morrow BR et al (2004) In vitro biomechanics of cervical disc arthroplasty with Prodisc-C total disc implant. Neurosurg Focus 17(3):44–54CrossRef DiAngelo DJ, Foley KT, Morrow BR et al (2004) In vitro biomechanics of cervical disc arthroplasty with Prodisc-C total disc implant. Neurosurg Focus 17(3):44–54CrossRef
18.
go back to reference DiAngelo DJ, Foley KT (2004) An improved biomechanical testing protocol for evaluating spinal arthroplasty and motion preservation devices in a multilevel human cadaveric cervical model. Neurosurg Focus 17(3):22–29 DiAngelo DJ, Foley KT (2004) An improved biomechanical testing protocol for evaluating spinal arthroplasty and motion preservation devices in a multilevel human cadaveric cervical model. Neurosurg Focus 17(3):22–29
19.
go back to reference Goffin J, Geusens E, Vantomme N et al (2004) Long-term follow-up after interbody fusion of the cervical spine. J Spinal Disord Tech 17:79–85PubMed Goffin J, Geusens E, Vantomme N et al (2004) Long-term follow-up after interbody fusion of the cervical spine. J Spinal Disord Tech 17:79–85PubMed
20.
go back to reference Hilibrand AS, Carlson GD, Palumbo MA et al (1999) Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 81:519–528PubMed Hilibrand AS, Carlson GD, Palumbo MA et al (1999) Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 81:519–528PubMed
21.
go back to reference Hilibrand AS, Robbins M (2004) Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J 4:190S–194SPubMedCrossRef Hilibrand AS, Robbins M (2004) Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J 4:190S–194SPubMedCrossRef
22.
go back to reference Katsuura A, Hukuda S, Saruhashi Y et al (2001) Kyphotic malalignment after anterior cervical fusion s one of the factors promoting the degenerative process in adjacent intervertebral levels. Eur Spine J 10:320–324PubMedCrossRef Katsuura A, Hukuda S, Saruhashi Y et al (2001) Kyphotic malalignment after anterior cervical fusion s one of the factors promoting the degenerative process in adjacent intervertebral levels. Eur Spine J 10:320–324PubMedCrossRef
23.
go back to reference Kulkarni V, Rajshekhar V, Raghuram L (2004) Accelerated spondylotic changes adjacent to the fused segments following central cervical corpectomy: magnetic resonance imaging study evidence. J Neurosurg Spine 1(100):2–6CrossRef Kulkarni V, Rajshekhar V, Raghuram L (2004) Accelerated spondylotic changes adjacent to the fused segments following central cervical corpectomy: magnetic resonance imaging study evidence. J Neurosurg Spine 1(100):2–6CrossRef
24.
go back to reference Robertson JT, Papadopoulos SM, Traynelis VC (2005) Assessment of adjacent-segment disease in patients treated with cervical fusion or arthroplasty: a prospective 2-year study. J Neurosurg Spine 3:417–423PubMedCrossRef Robertson JT, Papadopoulos SM, Traynelis VC (2005) Assessment of adjacent-segment disease in patients treated with cervical fusion or arthroplasty: a prospective 2-year study. J Neurosurg Spine 3:417–423PubMedCrossRef
25.
go back to reference Wang JC, McDonough PW, Endow K (1999) The effect of cervical plating on single-level anterior cervical discectomy and fusion. J Spinal Disord 12:467–471PubMedCrossRef Wang JC, McDonough PW, Endow K (1999) The effect of cervical plating on single-level anterior cervical discectomy and fusion. J Spinal Disord 12:467–471PubMedCrossRef
26.
go back to reference 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 Spine 1(96):17–21CrossRef 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 Spine 1(96):17–21CrossRef
27.
go back to reference Gore DR, Sepic SB (1998) Anterior discectomy and fusion for painful cervical disc disease. A report of 50 patients with an average follow-up of 21 years. Spine 23:2047–2051PubMedCrossRef Gore DR, Sepic SB (1998) Anterior discectomy and fusion for painful cervical disc disease. A report of 50 patients with an average follow-up of 21 years. Spine 23:2047–2051PubMedCrossRef
28.
29.
go back to reference Oskouian RJ, Whitehill R, Samii A et al (2004) The future of spinal arthroplasty: a biomaterial perspective. Neurosurg Focus 17(3):10–14CrossRef Oskouian RJ, Whitehill R, Samii A et al (2004) The future of spinal arthroplasty: a biomaterial perspective. Neurosurg Focus 17(3):10–14CrossRef
30.
go back to reference Smith HE, Wimberley DW, Vaccaro AR (2004) Cervical arthroplasty: material properties. Neurosurg Focus 17(3):15–21CrossRef Smith HE, Wimberley DW, Vaccaro AR (2004) Cervical arthroplasty: material properties. Neurosurg Focus 17(3):15–21CrossRef
31.
go back to reference Coric D, Finger F, Boltes P (2006) Prospective randomized controlled study of the Bryan Cervical Disc: early clinical results from a single investigational site. J Neurosurg Spine 4:31–35PubMedCrossRef Coric D, Finger F, Boltes P (2006) Prospective randomized controlled study of the Bryan Cervical Disc: early clinical results from a single investigational site. J Neurosurg Spine 4:31–35PubMedCrossRef
32.
go back to reference Cummins BH, Robertson JT, Gill SS (1998) Surgical experience with an implanted artificial cervical joint. J Neurosurg 88:943–948PubMed Cummins BH, Robertson JT, Gill SS (1998) Surgical experience with an implanted artificial cervical joint. J Neurosurg 88:943–948PubMed
33.
go back to reference Goffin J, Casey A, Kehr P et al (2002) Preliminary clinical experience with the Bryan cervical disc prosthesis. Neurosurgery 51:840–847PubMedCrossRef Goffin J, Casey A, Kehr P et al (2002) Preliminary clinical experience with the Bryan cervical disc prosthesis. Neurosurgery 51:840–847PubMedCrossRef
34.
go back to reference Goffin J, Van Calenbergh F, van Loon J et al (2003) Intermediate follow-up after treatment of degenerative disc disease with the Bryan Cervical Disc Prosthesis: single-level and bi-level. Spine 28:2673–2678PubMedCrossRef Goffin J, Van Calenbergh F, van Loon J et al (2003) Intermediate follow-up after treatment of degenerative disc disease with the Bryan Cervical Disc Prosthesis: single-level and bi-level. Spine 28:2673–2678PubMedCrossRef
35.
go back to reference Sekhon LHS, Sears W, Duggal N (2005) Cervical arthroplasty after previous surgery: results of treating 24 discs in 15 patients. J Neurosurg Spine 3:335–341PubMedCrossRef Sekhon LHS, Sears W, Duggal N (2005) Cervical arthroplasty after previous surgery: results of treating 24 discs in 15 patients. J Neurosurg Spine 3:335–341PubMedCrossRef
37.
go back to reference Wigfield CC, Gill SS, Nelson RJ et al (2002) The new Frenchay artificial cervical joint: results from a two-year pilot study. Spine 27:2446–2452PubMedCrossRef Wigfield CC, Gill SS, Nelson RJ et al (2002) The new Frenchay artificial cervical joint: results from a two-year pilot study. Spine 27:2446–2452PubMedCrossRef
38.
go back to reference Le H, Thongtrangan I, Kim DH (2004) Historical review of cervical arthroplasty. Neurosurg Focus 17(3):1–9CrossRef Le H, Thongtrangan I, Kim DH (2004) Historical review of cervical arthroplasty. Neurosurg Focus 17(3):1–9CrossRef
39.
40.
go back to reference Kettler A, Wilke H-J (2006) Review of existing grading systems for cervical and lumbar disc and facet joint degeneration. Eur Spine J 15:705–718PubMedCrossRef Kettler A, Wilke H-J (2006) Review of existing grading systems for cervical and lumbar disc and facet joint degeneration. Eur Spine J 15:705–718PubMedCrossRef
41.
go back to reference Yoon DH, Yi S, Shin HC et al (2006) Clinical and radiological results following cervical arthroplasty. Acta Neurochir (Wien) 148(9):943–950CrossRef Yoon DH, Yi S, Shin HC et al (2006) Clinical and radiological results following cervical arthroplasty. Acta Neurochir (Wien) 148(9):943–950CrossRef
Metadata
Title
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?
Authors
Giuseppe M. V. Barbagallo
Roberto Assietti
Leonardo Corbino
Giuseppe Olindo
Pietro V. Foti
Vittorio Russo
Vincenzo Albanese
Publication date
01-06-2009
Publisher
Springer-Verlag
Published in
European Spine Journal / Issue Special Issue 1/2009
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-009-0978-9

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