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Hybrid surgery for multilevel cervical degenerative disc diseases: a systematic review of biomechanical and clinical evidence

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Abstract

Purpose

The optimal surgical technique for multilevel cervical degenerative disc diseases (DDD) remains controversial. Hybrid surgery (HS) incorporating anterior cervical discectomy and fusion (ACDF) and cervical disc replacement (CDR) is increasingly performed for cervical DDD. This study aims to evaluate the biomechanical and clinical evidence available for HS and to provide a systematic review of current understanding of HS.

Methods

This systematic review was undertaken by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. Multiple databases and online registers of clinical trials were searched up to February 2014. The biomechanical and clinical studies on HS for cervical DDD written in English were included. Two authors independently assessed methodological quality and extracted data.

Results

Fifteen studies including eight biomechanical studies and seven clinical studies were indentified. The biomechanical studies showed that HS was benefit to motion preservation of the operative levels and revealed less adverse effect on adjacent segments. All clinical studies demonstrated improvement in validated functional scores after HS. Segment motion and immobilization were achieved at the arthroplasty level and arthrodesis level, respectively. Postoperative assessments and complication rate were similar or in favor of HS when comparing with ACDF or CDR. However, the overall quality of evidence for HS was low to very low.

Conclusions

There is a paucity of high quality evidence for HS. HS may be a safe and efficacious technique to benefit a select group of multilevel cervical DDD, which is needed to be confirmed by further prospective, randomized controlled trials.

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Acknowledgments

This project was supported by the National Natural Science Foundation of China (Nos. 11120101001 and 11202017), the 111 Project (No. B13003), National Science & Technology Pillar Program (Nos. 2012BAI18B05, 2012BAI18B07 and 2012BAI22B02), Research Fund for the Doctoral Program of Higher Education of China (20131102130004).

Conflict of interest

None of the authors has any potential conflict of interest.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Navy General Hospital, Clinical School of Navy, Second Military Medical University, NO.6 Fucheng Road, Beijing, 100048, People’s Republic of China

    Zhiwei Jia, Fan Ding, Qing He & Dike Ruan

  2. Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, International Joint Research Center of Aerospace Biotechnology and Medical Engineering of Ministry of Science and Technology, School of Biological Science and Medical Engineering, Beihang University, XueYuan Road No.37, Beijing, 100191, People’s Republic of China

    Zhongjun Mo & Yubo Fan

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  1. Zhiwei Jia
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  2. Zhongjun Mo
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  3. Fan Ding
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  4. Qing He
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Corresponding authors

Correspondence to Yubo Fan or Dike Ruan.

Additional information

Z. Jia and Z. Mo have contributed equally to this work.

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Jia, Z., Mo, Z., Ding, F. et al. Hybrid surgery for multilevel cervical degenerative disc diseases: a systematic review of biomechanical and clinical evidence. Eur Spine J 23, 1619–1632 (2014). https://doi.org/10.1007/s00586-014-3389-5

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  • DOI: https://doi.org/10.1007/s00586-014-3389-5

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