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Hybrid Constructs in the Surgical Treatment of Degenerative Cervical Disc Disease: Five-Year Clinical and Radiological Follow Up

Introduction In most of the patients with multisegmental cervical degenerative disc disease the certain segments can show different stages of degeneration and instability. This condition may require an individual surgical strategy and the use of hybrid constructs with the combination of fusion and motion presevation implants. Our study was designed to investigate the clinical and radiological outcome of the combination of cervical fusion and arthroplasty in a prospective cohort. Material and Methods 36 patients with symptomatic cervical radiculopathy and/or myelopathy underwent hybrid cervical surgery between 2007 and 2010 (14 two-level, 16 three-level and 6 four-level surgeries were performed). VAS for pain, Neck Disability Index, neurologic function and the radiographic parameters (range of motion at the level of prosthesis and the cranial adjacent segment, the intervertebral disc height of the adjacent segment, cervical lordosis, heterotopic ossification) were evaluated during the study period. Results Improvement in pain was significant and sustained 5 year after the surgery (dVAS= 5.0, p < 0.05). The segment of the prosthesis ultimately showed the preservation of motion when compared with preoperative values (the preoperative mean flexion/extension ROM was 8.2° while the postoperative ROM was 7.6°). The mean cervical spine lordosis was preoperatively 1.7°, postoperatively 16.2° (p < 0.05). None of the patients has required further surgery because of symptomatic adjecent segment disease. Conclusion The results of the study support the theoretic advantage of the use of hybird constructs in selected cases. In our cohort, the 5-year clinical and radiological outcome of the multilevel cervical hybrid surgeries are promising. However, long-term follow up studies are required to prove its role in the surgical treatment of the multisegmental degenerative cases.