April 08, 2016
1 min read

Study: Three-level hybrid cervical spine surgery may be preferable to all-fusion surgery

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LAS VEGAS — Three-level cervical surgery, which consisted of two-level anterior cervical discectomy and fusion with one-level cervical disc replacement, was a viable procedure for the treatment of cervical disc disease, according to data presented at the International Society for the Advancement of Spine Surgery Annual Meeting.

The treatment also was associated with no added neck pain or adjacent segment issues for patients, according to Jung-Woo Hur, MD, of the Department of Neurosurgery at Seoul St. Mary’s Hospital in Seoul, South Korea, who presented results of the retrospective study, here. Hur and colleagues theorized the hybrid surgery may be a reasonable alternative to multilevel ACDF and one that might mitigate symptomatic adjacent segment degeneration.

“The hybrid surgery consisting of two-level ACDF and one-level ADR was shown to be as safe and effective as three-level ACDF for cervical disc disease (CDD),” Hur said.

Hur and colleagues matched 18 patients operated on at C2-7 with the hybrid construct consisting of two-level anterior cervical discectomy and fusion (ACDF) and one-level cervical disc replacement (CDR) with 18 patients who were treated with three-level ACDF. The hybrid surgeries were performed with a standard Smith-Robinson approach between May 2008 and September 2012.

When the researchers analyzed the patients’ outcomes using the VAS and Neck Disability Index scores, they found both groups significantly improved postoperatively and the improvements continued through the 2-year follow-up. Radiographic analysis showed the hybrid patients were hypomobile during the follow-up periods. The investigators also observed significant recovery of lordosis in both groups compared to preoperative levels.

“For the evidence of adjacent segment degeneration, there were two cases of new osteophyte formation in the ACDF group and there was an equal number of four patients with disc narrowing in the hybrid and the ACDF group,” Hur said.

He concluded, “Compared with ACDF, the hybrid surgery had better neck pain improvement, C2-7 range of motion and less impact at the adjacent segment. The hybrid surgery may be a promising alternative to fusion surgery for CDD, but this is 2-year follow-up. So long-term follow-up may be warranted.” – by Susan M. Rapp


Hur J-W, et al. Paper #133. Presented at: International Society for the Advancement of Spine Surgery Annual Meeting; April 6-8, 2016; Las Vegas.

Disclosure: Hur reports no relevant financial disclosures.