title: Clinical and radiological outcomes following hybrid surgery in the treatment of multi-level cervical spondylosis: over a 2-year follow-up.
abstract: BACKGROUND
  The optimal surgical approach for treatment of multi-level cervical disc disease is currently widely debated. Anterior cervical discectomy and fusion (ACDF) combined with cervical disc arthroplasty (CDA) has been presented as a treatment approach, but to date, there are few reports with adequate clinical and radiological data for this hybrid surgical procedure. The goal of this paper is to assess clinical and radiological outcomes in patients with cervical spondylosis in three contiguous segments after treatment with artificial disc replacement combined with fusion.
  
  
  METHODS
  We performed a retrospective review of 36 patients (mean age of 48.6 years) with contiguous three-level cervical spondylosis who were treated with ACDF coupled with CDA (hybrid surgery) between October 2008 and October 2012. Clinical evaluation was based on the Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA) score, and postoperative JOA score improvement rate (IR). Radiographic parameters, angular range of motion (ROM) for C2-C7, and ROM for the superior and inferior adjacent segments were measured before the operation, at 1, 3, 6, and 12 months postoperation, and at the final follow-up evaluation. All cases were followed for at least 28 months (range 28-65 months).
  
  
  RESULTS
  All patients exhibited significant postoperative improvement in NDI and JOA scores compared to preoperative levels (P < 0.05), and these improved scores were maintained during the follow-up period. The JOA score improvement rate was 70.83 % at the final follow-up evaluation. The mean C2-C7 ROM of all cases was significantly decreased immediately after operation but recovered to preoperative levels after 12 months (P = 0.721). The ROM of the superior and inferior adjacent segments was recovered to preoperative levels after 6 months (P > 0.05). One patient required a second surgery for symptomatic adjacent segment degeneration. Neither pseudarthrosis nor other device migration was observed in any patients during the entire follow-up period.
  
  
  CONCLUSIONS
  These results indicate that hybrid surgery seems to be a promising, acceptable, and alternative surgical approach for the treatment of multi-level cervical disc disease.
authors.affiliation: Department of Orthopedics, Hospital of Orthopedics, The 175th Hospital of PLA, Southeast Hospital of Xiamen University, No. 269 Zhanghua Road, Zhangzhou, 363000, Fujian, People's Republic of China.
authors.forename: Ji-Sheng
authors.initials: JS
authors.lastname: Shi
authors.affiliation: Department of Orthopedics, Hospital of Orthopedics, The 175th Hospital of PLA, Southeast Hospital of Xiamen University, No. 269 Zhanghua Road, Zhangzhou, 363000, Fujian, People's Republic of China. 754681652@qq.com.
authors.forename: Bin
authors.initials: B
authors.lastname: Lin
authors.affiliation: Department of Orthopedics, Hospital of Orthopedics, The 175th Hospital of PLA, Southeast Hospital of Xiamen University, No. 269 Zhanghua Road, Zhangzhou, 363000, Fujian, People's Republic of China.
authors.forename: Chao
authors.initials: C
authors.lastname: Xue
authors.affiliation: Department of Orthopedics, Hospital of Orthopedics, The 175th Hospital of PLA, Southeast Hospital of Xiamen University, No. 269 Zhanghua Road, Zhangzhou, 363000, Fujian, People's Republic of China.
authors.forename: Hai-Shen
authors.initials: HS
authors.lastname: Zhang
authors.affiliation: Department of Orthopedics, Hospital of Orthopedics, The 175th Hospital of PLA, Southeast Hospital of Xiamen University, No. 269 Zhanghua Road, Zhangzhou, 363000, Fujian, People's Republic of China.
authors.forename: Zhi-Da
authors.initials: ZD
authors.lastname: Chen
authors.affiliation: Department of Orthopedics, Hospital of Orthopedics, The 175th Hospital of PLA, Southeast Hospital of Xiamen University, No. 269 Zhanghua Road, Zhangzhou, 363000, Fujian, People's Republic of China.
authors.forename: Zhong-Sheng
authors.initials: ZS
authors.lastname: Zhao
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods* / Q000639:trends*; D055009:Spondylosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D013997:Time Factors; D059145:Total Disc Replacement / Q000379:methods* / Q000639:trends; D016896:Treatment Outcome