title: Is hybrid surgery of the cervical spine a good balance between fusion and arthroplasty? Pilot results from a single surgeon series.
abstract: OBJECTIVE
  Few studies have investigated the role of hybrid surgery (HS) that incorporates anterior cervical discectomy and fusion (ACDF) and artificial disc replacement (ADR) techniques. To our knowledge, this is the first study that provides a direct comparison of all three groups in terms of intra-operative parameters and outcomes with a minimum follow-up of 2 years.
  
  
  METHODS
  Seven consecutive patients who underwent HS were matched with another seven patients who underwent ACDF and ADR based on levels of surgery. Prospective data on demographics, pre-operative and post-operative assessments, complications and functional scores (VAS, NDI, EQ-5D health score and index) were analysed using Mann-Whitney U test. Type I error was set at 5 %.
  
  
  RESULTS
  Duration of surgery was significantly shorter for ACDF at 135 min (p = 0.025) compared with HS and ADR. ACDF also had greater blood loss when compared with ADR (p < 0.036). ADR has the shortest duration of hospitalization followed by HS and ACDF (p < 0.031). The HS group returned to work fastest (54 days) when compared with both ACDF (107 days) and ADR (73 days) with statistical significance seen between HS and ACDF (p = 0.035). Cervical range of motion (ROM) and functional scores did not show any significant differences.
  
  
  CONCLUSIONS
  HS is comparable to ACDF and ADR in terms of safety and feasibility. Findings of shorter in-hospital stay and earlier return to work in HS group may be further explored in large, randomised controlled trials.
authors.affiliation: Department of Orthopaedic Surgery, National University Hospital, National University Singapore, National University Health System, 1E Kent Ridge Road, 119228 Singapore, Singapore. hwee_weng_hey@nuhs.edu.sg
authors.forename: Hwee Weng Dennis
authors.initials: HW
authors.lastname: Hey
authors.forename: Choon Chiet
authors.initials: CC
authors.lastname: Hong
authors.forename: Ai Sha
authors.initials: AS
authors.lastname: Long
authors.forename: Hwan Tak
authors.initials: HT
authors.lastname: Hee
mesh_terms: D002574:Cervical Vertebrae / Q000601:surgery*; D017586:Diskectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D016059:Range of Motion, Articular; D020127:Recovery of Function; D013123:Spinal Fusion / Q000379:methods*; D059145:Total Disc Replacement / Q000379:methods*