Comparison Of Hybrid Surgery Versus Multilevel Fusion For Multilevel Cervical Spondylosis: A Meta-analysis

Background:The optimal surgical treatment of multilevel cervical spondylosis remains controversial.Due to excellent clinical efficacy,anterior cervical discectomy and fusion is widely recognized a standard operative treatment for cervical spondylosis.However,more and more studies show that it can reduce motion function and cause adjacent segment degeneration,especially in multilevel cervical spondylosis.Hybrid surgery incorporating anterior cervical discectomy and fusion and artificial arthroplasty begin to apply gradually,but few studies have reported the safety and efficacy of hybrid surgery,and some of the studies comparing HS with ACDF have reported conflicting results.Objective:To clarify the advantages of hybrid surgery in the treatment of multilevel cervical spondylosis compare with anterior cervical discectomy and fusion.Methods:We performed a systematic literature search in PubMed,Medline,Embase,Cochrane library,China Biology Medicine and China National Knowledge Infrastructure to identify relevant controlled trials published up to October 2015 and assessed the quality of literature.The standardized mean differenceand 95% confidence intervalof the perioperative parameters,visual analogue scale pain score,neck disability index,and range of motion of C2-C7 and adjacent segments were calculated.We also analyzed complications and Odom scale scores using risk difference and 95% CI.Review Manager 5.2 and Stata 12.0 software was used to perform meta-analysis,sensitivity analysis and publication bias analysis.Results:In total,7 studies were included.The pooled data exhibited no significant differences in operation time,complications,visual analogue scale pain score,neck disability index or Odom scale scores between the 2 groups.However,the mean blood loss in hybrid surgery was less.Furthermore,after postoperative 12 months to the last follow-up,the range of motion of C2-C7 in hybrid surgery group was higher.After postoperative 1 month to the last follow-up,the range of motion of superior adjacent segments in hybrid surgery group was lower than fusion group.After postoperative 3 month to the last follow-up,the range of motion of inferior adjacent segments in hybrid surgery group was lower.Conclusions:The safety of hybrid surgery may be as good as that of anterior cervical discectomy and fusion.Furthermore,it is superior to fusion in conserving mobility of cervical spine and decreasing adjacent-segment hyperkinesia,which make cervical spine like natural kinematic condition.However,the results should be accepted cautiously due to the limitations of the study.Studies with larger sample sizes and longer follow-up periods are required to confirm and update the results of the present study.