title: Clinical and radiological results of two hybrid reconstructive techniques in noncontiguous 3-level cervical spondylosis.
abstract: OBJECTIVE
  To date, formulation of the optimal surgical protocol for noncontiguous multilevel cervical spondylosis remains controversial, and the corresponding clinical data continue to be limited. The purpose of this study was to compare the clinical and radiological outcomes of two hybrid reconstructive techniques in noncontiguous 3-level cervical spondylosis (2 contiguous disc levels and 1 "skip" disc level [nonoperated level between 2 operated levels]). The incidence of adjacent-segment degeneration (ASD) was also evaluated.
  
  
  METHODS
  Sixty-three consecutive patients with noncontiguous 3-level cervical spondylosis who underwent two different hybrid methods of treatment were retrospectively reviewed. The patients were divided into 2 groups, the fusion group and the arthroplasty group. A titanium mesh cage and an anterior cervical plate were used after the anterior cervical corpectomy, and then a stand-alone cage (the fusion group) or an artificial cervical disc (the arthroplasty group) was used after the discectomy. Clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA) scale score and the JOA scale score improvement rate preoperatively and during follow-up. Radiological results were assessed using global angle and global range of motion (ROM) of the cervical spine. The ASD was also evaluated.
  
  
  RESULTS
  The JOA scores of the patients significantly improved postoperatively and were well maintained within the follow-up period, as did the JOA scale score improvement rate. The mean global angle of the cervical spine of the patients significantly increased postoperatively. At the last follow-up evaluation, the mean global ROM was retained by patients in the arthroplasty group (p > 0.05) but not by patients in the fusion group (p = 0.00). There was no significant difference in the incidence of ASD between the 2 groups (p = 0.114). However, at the skip levels, patients in the fusion group had a higher incidence of ASD than patients in the arthroplasty group (p = 0.038).
  
  
  CONCLUSIONS
  Both of the hybrid procedures (anterior cervical corpectomy and fusion [ACCF] + anterior cervical discectomy and fusion, and ACCF + cervical disc arthroplasty [CDA]) yielded favorable clinical and radiological outcomes in the treatment of noncontiguous 3-level cervical spondylosis. Moreover, the ACCF + CDA procedure may have the ability to decrease the likelihood of ASD in appropriate patients.
authors.affiliation: Department of Orthopedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Lisheng
authors.initials: L
authors.lastname: Kan
authors.forename: Jian
authors.initials: J
authors.lastname: Kang
authors.forename: Rui
authors.initials: R
authors.lastname: Gao
authors.forename: Xiongsheng
authors.initials: X
authors.lastname: Chen
authors.forename: Lianshun
authors.initials: L
authors.lastname: Jia
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods; D017586:Diskectomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011300:Preoperative Care; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D055009:Spondylosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D016896:Treatment Outcome
keywords: ACCF = anterior cervical corpectomy and fusion; ACDF = anterior cervical discectomy and fusion; ASD = adjacent-segment degeneration; CDA = cervical disc arthroplasty; JOA = Japanese Orthopaedic Association; ROM = range of motion; adjacent-segment degeneration; anterior cervical decompression and fusion; cervical disc arthroplasty; hybrid reconstructive techniques; noncontiguous multilevel cervical spondylosis