Study On The Application Of Hibird Surgery In The Treatment Of Multilevel Cervical Spondylosis And Investigate Other Surgical Methods

Part I The application and efficacy of Hibird surgery for the multilevel cervical spondylosisObjective To investigate the application of Hybrid surgery for the multilevel cervical spodylosis and evauate its clinical efficacy. Methods32patients with multilevel cervical spodylosis at our hospital between January2011and April2013were treated by Hybird surgery, which combined non-fusion and fusion technique. There were18male and14female patients, aged from29to58years(average39.4). There were7patients of cervical spondylotic radiculopathy,16patients of cervical spondylotic myelopathy and9mixed cervical spondylosis. The Hybird surgery including single-level artificial disc replacement and corpectomy fusion were performed in all the patients. The postoperative complications were assessed. Preoperative and postoperative visual analog scale(VAS),neck disability index(NDI),quality of life scale(SF-36) and Japanese orthopaedic association(JOA) were recorded. The cervical sagittal alignment, range of motion(ROM) for C2-C7and adjacent segments were measured by cervical X-ray radiographs. Results32patients were followed up from12to40months, average23.6months. All the patients had an improvement of neurological function. Loosening of prosthesis occurred in1case, while other cases had no complication such as loosening, displacement and subsiding. Dysphagia occurred in14patients and hoarseness occurred in4cases. There were significant difference of VAS score、JOA score、NDI score and SF-36score at last follow-up (P<0.05). The excellent and good rate was87.4%by the Odom criterion. The postoperative ROM of C2-7was decreased, but the ROM of adjacent segments was increased. Conclusions Hybird surgery of non-fusion and fusion technique was safe and effective in the treatment of multilevel cervical spondylosis. Its clinical efficacy was statisfied. The motion of the non-fusion segments was reserved while the decompression was complete. It could be an alternative technique for the spinal surgeon in the treatment for multilevel cervical spondylosis. Part Ⅱ The outcomes of Hibird surgery compared with anterior cervical discectomy and fusionObjective To compare the clinical outcomes of Hybird surgery(HS) and anterior cervical discectomy and fusion(ACDF) in the treatment of patients with multilevel cervical spondylosis. Methods52patients with multilevel cervical spondylosis at our department between Jan2011and Jan2013were treated by cervical surgey,32patients of the HS group were matched to30patients of the ACDF group.All the patients were interviewed at1week,1,3,12and24months postoperation.The surgical time, blood loss, postoperative complications,Japanese orthopaedic association (JOA),neck disability index(NDI),quality of life scale(SF-36) and visual analog scale(VAS) were evaluated before surgery and at routine intervals by questionnaires. The angular range of motion(ROM) for C2-C7and adjacent segments were measured by dynamic flexion and extension lateral cervical radiographs using the Cobb method. Results All the patients had an improvement of neurological function without serious complication in both groups, but the HS group had less surgical time, blood loss compared to the ACDF group(P<0.05).There were no difference in VAS score, JOA score, NDI score,SF-36score between the two groups(P>0.05). The C2-7ROM did not recover to the preoperation in two groups, but the HS group had a better and faster C2-7ROM recovery. The ROM of adjacent segments was increased in both groups, but the ACDF group had more ROM of ASD. Conclusions The clinical outcomes showed that the Hybird surgery is a reasonable alternatine to ACDF in the case of multilevel cervical spondylosis, while it can reduce surgical time,blood loss and complications. What is more, less compensatory motion of adjacent segments and less ASD occur in Hybird surgery. Part Ⅲ Early clinical efficacy analysis on three-level artificial disc replacementObjective To investigate the early clinical efficacy of three-level artificial disc replacement. Methods6patients with multilevel cervical spodylosis in our hospital between April2012and April2013were treated by three-level artificial disc replacement, including4male and2female patients, aged from31to55years(average,42.4). The operation time、blood loss、bedtime in hospital、 postoperative complications were assessed. Preoperative and postoperative visual analog scale(VAS),neck disability index(NDI),quality of life scale(SF-36) and Japanese orthopaedic association(JOA) were recorded. The cervical sagittal alignment, range of motion(ROM) for C2-C7、surgical and adjacent segments were measured by cervical X-ray radiographs. Results6patients were followed up from6to24months, average15.6months. All the patients had an improvement of neurological function. There were no complication such as loosening, displacement and subsiding. There were significant difference of VAS score, JO A score, NDI score and SF-36score at last follow-up (P<0.05). The excellent and good rate was83.3%by the Odom criterion. The postoperative ROM of C2-7、surgical and adjacent segments almost equated to preoperation. Conclusions Three-level artificial disc replacement was safe and reliable in the treatment of multilevel cervical spondylosis. Its early clinical efficacy was statisfied. It can achieve complete decompression while preserve the motion of the cervical spine. But the further outcomes need more follow-up.