title: A systematic review and meta-analysis of outcomes in hybrid constructs for multi-level lumbar degenerative disc disease.
abstract: A systematic review and meta-analysis was performed to assess the effect of hybrid constructs which involve a total disc arthroplasty (TDA) with stand-alone anterior lumbar interbody fusion (ALIF) versus non-hybrid constructs including multi-level TDA, multi-level transforaminal lumbar interbody fusion (TLIF) with posterior transpedicular fixation or multi-level stand-alone ALIF as a surgical intervention for degenerative disc disease (DDD) in the lumbar spine. Primary outcomes analysed included the Oswestry Disability Index (ODI) and the Visual Analogue Scale (VAS) for back pain. A systematic search of Medline, Embase, Pubmed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Google Scholar was undertaken by two separate reviewers and a meta-analysis of the outcomes was performed. Three studies met our search criteria. When comparing hybrid constructs to multi-level TDA or lumbar fusion (LF) improvements in back pain were found with a VAS back pain score reduction of 1.38 (P<0.00001) postoperatively and a VAS back pain score reduction of 0.99 points (P=0.0006) at 2-years follow-up. Results so far slightly favour clinically significant improved VAS back pain score outcomes postoperatively and at 2-years follow-up for hybrid constructs in multi-level lumbar DDD of the spine when compared with non-hybrid multi-level LF or TDA. It cannot however be concluded that a hybrid construct is superior to multi-level LF or TDA based on this meta-analysis. The results highlight the need for further prospective studies to delineate best practice in the management of degenerative disc disease of the lumbar spine.
authors.affiliation: Brizbrain and Spine, The Wesley Hospital, Evan Thomson Building, Suite 20, Level 10, Chasely Street, Auchenflower, QLD 4066, Australia. Electronic address: alan.lackey@gmail.com.
authors.forename: Alan
authors.initials: A
authors.lastname: Lackey
authors.affiliation: NeuroSpine Surgery Research Group (NSURG), Sydney, NSW, Australia; NeuroSpine Clinic, Prince of Wales Private Hospital, Randwick, Sydney, Australia; University of New South Wales, Sydney, NSW, Australia.
authors.forename: Kevin
authors.initials: K
authors.lastname: Phan
authors.affiliation: NeuroSpine Surgery Research Group (NSURG), Sydney, NSW, Australia; NeuroSpine Clinic, Prince of Wales Private Hospital, Randwick, Sydney, Australia; University of New South Wales, Sydney, NSW, Australia.
authors.forename: Ralph
authors.initials: R
authors.lastname: Mobbs
mesh_terms: D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D013123:Spinal Fusion / Q000379:methods*; D059145:Total Disc Replacement / Q000379:methods*
keywords: Back pain; Intervertebral disc disease; Lumbar vertebrae; Spinal fusion; Total disc replacement