Abstract
Objective
To examine the short-term efficacy and imaging results of using the Mobi-C in cervical hybrid surgery on 2-level cervical spondylolisthesis. To observe post-operative changes in the flexion–extension centre of rotation (FE-COR) and anterior bone loss (ABL) of the anterior cervical disc replacement (ACDR) segment.
Methods
Forty-two patients (20 males and 22 females, aged 42‒67 years) who underwent cervical hybrid surgery were retrospectively analysed. Their ACDR segment used Mobi-C, and the fusion segment used ROI-C, with a follow-up of 25‒42 months (31.1 ± 4.8 months). The modified Japanese Orthopaedic Association (mJOA) score, Neck Disability Index (NDI), and visual analogue scale (VAS) were used to assess clinical outcomes. Pre-operative, 6-month post-operative, and final follow-up radiographs were collected to compare total cervical spine curvature (C2–C7), curvature of the operated segments, range of motion (ROM) in the total cervical spine, operated segmental ROM, ACDR segmental ROM, and operated adjacent segmental ROM. The height of the superior articular process (HSAP), the orientation of zygapophyseal joint spaces (OZJS), and the length of the superior articular surface (LSAS) were measured. The FE-COR of the ACDR segment was measured using the mid-plumb line method. The translation distance of the Mobi-C was measured. The degree of disc degeneration in the adjacent segment, bony fusion of the ACDF segment, and ABL of the upper and lower vertebra of the ACDR segment were observed.
Results
In our group, all patients have shown improvements in their postoperative mJOA, NDI, and VAS scores. Overall cervical ROM and surgical segmental ROM decreased (P < 0.05). However, there was no significant decrease in ACDR segmental ROM and upper or lower adjacent segmental ROM compared with pre-operatively (P > 0.05). For FE-COR-X, only the last follow-up compared with pre-surgery showed statistical significance (46.74 ± 7.71% vs. 50.74 ± 6.92%, P < 0.05). For FE-COR-Y, the change was statistically significant at both 6 months post-operation and the final follow-up compared to pre-operation (45.37% ± 21.11% vs. 33.82% ± 10.87%, 45. 37% ± 21.11% vs. 27.48% ± 13.58%, P < 0.05). No significant difference in the Mobi-C translation distance was observed (P > 0.05). Moreover, the difference in HSAP was not statistically significant at each node (P > 0.05). The OZJS and LSAS were significantly different at the final follow-up compared to the pre-operative period (P < 0.05). All the ACDF segments were observed in a stable condition at the final follow-up. Furthermore, 9 of the adjacent segments showed imaging ASD (9/82, 10.98%), and all were present at the last follow-up, of which 6 were mild, and 3 were moderate. Twenty of the 42 Mobi-C segments had no significant ABL (grade 0) 6 months post-operatively (47.62%). Sixteen cases (38.10%) showed mild ABL (grade 1), and 6 cases (14.28%) showed moderate ABL (grade 2). No severe ABL occurred.
Conclusion
The cervical hybrid surgery using Mobi-C artificial cervical discs can achieve satisfactory results. The Mobi-C segmental FE-COR-X shows a slow forward shift trend, and FE-COR-Y drops noticeably within 6 months post-surgery before stabilizing. It’s common to see mild to moderate ABL after cervical hybrid surgery using Mobi-C, and significant progression is unlikely in the short term. Furthermore, changes in the FE-COR after hybrid surgery in the Mobi-C segment might not affect clinical outcomes.
Data availability
The data that support the findings of this study are available from the corresponding author upon reasonable request.
References
Lu VM, Zhang L, Scherman DB, Rao PJ, Mobbs RJ, Phan K (2017) Treating multi-level cervical disc disease with hybrid surgery compared to anterior cervical discectomy and fusion: a systematic review and meta-analysis. Eur Spine J 26(2):546–557. https://doi.org/10.1007/s00586-016-4791-y
Jia Z, Mo Z, Ding F, He Q, Fan Y, Ruan D (2014) Hybrid surgery for multilevel cervical degenerative disc diseases: a systematic review of biomechanical and clinical evidence. Eur Spine J 23(8):1619–1632. https://doi.org/10.1007/s00586-014-3389-5
Peng Z, Hong Y, Meng Y, Liu H (2022) A meta-analysis comparing the short- and mid- to long-term outcomes of artificial cervical disc replacement (ACDR) with anterior cervical discectomy and fusion (ACDF) for the treatment of cervical degenerative disc disease. Int Orthop 46(7):1609–1625. https://doi.org/10.1007/s00264-022-05318-z
Tian P, Fu X, Li ZJ, Sun XL, Ma XL (2015) Hybrid surgery versus anterior cervical discectomy and fusion for multilevel cervical degenerative disc diseases: a meta-analysis. Sci Rep 5:13454. https://doi.org/10.1038/srep13454
Grasso G (2015) Clinical and radiological features of hybrid surgery in multilevel cervical degenerative disc disease. Eur Spine J Suppl 7:842–848. https://doi.org/10.1007/s00586-015-4281-7
Roberts TT, Filler RJ, Savage JW, Benzel EC (2018) Cervical total disk arthroplasty. Clin Spine Surg 31(1):6–13. https://doi.org/10.1097/BSD.0000000000000607
Alves ÓL (2021) Cervical total disc replacement: expanded indications. Neurosurg Clin N Am 32(4):437–448. https://doi.org/10.1016/j.nec.2021.05.002
Salari B, McAfee PC (2012) Cervical total disk replacement: complications and avoidance. Orthop Clin North Am 43(1):97–107. https://doi.org/10.1016/j.ocl.2011.08.006
Loidolt T, Kurra S, Riew KD et al (2021) Comparison of adverse events between cervical disc arthroplasty and anterior cervical discectomy and fusion: a 10-year follow-up. Spine J 21(2):253–264. https://doi.org/10.1016/j.spinee.2020.10.013
Chen TY, Chen WH, Tzeng CY, Huang CW, Yang CC, Chen HT et al (2020) Anterior bone loss after cervical Bryan disc arthroplasty: insight into the biomechanics following total disc replacement. Spine J 20(8):1211–1218. https://doi.org/10.1016/j.spinee.2020.04.017
Wang XF, Meng Y, Liu H, Wang BY, Hong Y (2020) Incidence and outcomes of anterior bone loss in single-level prestige LP cervical disc replacement. Chin Med J (Engl) 134(1):109–111. https://doi.org/10.1097/CM9.0000000000001254
Heo DH, Lee DC, Oh JY, Park CK (2017) Bone loss of vertebral bodies at the operative segment after cervical arthroplasty: a potential complication? Neurosurg Focus 42(2):E7. https://doi.org/10.3171/2016.10.FOCUS16393
Kieser DC, Cawley DT, Fujishiro T, Tavolaro C, Mazas S, Boissiere L et al (2019) Anterior bone loss in cervical disc arthroplasty. Asian Spine J 13(1):13–21. https://doi.org/10.31616/asj.2018.0008
Lin CY, Kang H, Rouleau JP, Hollister SJ, Marca FL (2009) Stress analysis of the interface between cervical vertebrae end plates and the Bryan, Prestige LP, and ProDisc-C cervical disc prostheses: an in vivo image-based finite element study. Spine (Phila Pa 1976) 34(15):1554–1560. https://doi.org/10.1097/BRS.0b013e3181aa643b
Mo Z, Li Q, Jia Z, Yang J, Wong DW, Fan Y (2017) Biomechanical consideration of prosthesis selection in hybrid surgery for bi-level cervical disc degenerative diseases. Eur Spine J 26(4):1181–1190. https://doi.org/10.1007/s00586-016-4777-9
Sang H, Cui W, Sang D, Guo Z, Liu B (2020) How center of rotation changes and what affects these after cervical arthroplasty: a systematic review and meta-analysis. World Neurosurg 135:e702–e709. https://doi.org/10.1016/j.wneu.2019.12.111
van Mameren H, Sanches H, Beursgens J, Drukker J (1992) Cervical spine motion in the sagittal plane. II. Position of segmental averaged instantaneous centers of rotation—a cineradiographic study. Spine 17(5):467–474. https://doi.org/10.1097/00007632-199205000-00001
Li C, Yu X, Xiong Y, Yang Y, Wang F, Zhao H (2022) Mid-long-term follow-up of operated level kinematics after single-level artificial cervical disc replacement with Bryan disc. J Orthop Surg Res 17(1):149. https://doi.org/10.1186/s13018-022-03051-2
Nunley P, Frank K, Stone M (2020) Patient Selection in cervical disc arthroplasty. Int J Spine Surg 14(s2):S29–S35. https://doi.org/10.14444/7088
Nowitzke A, Westaway M, Bogduk N (1994) Cervical zygapophyseal joints: geometrical parameters and relationship to cervical kinematics. Clin Biomech (Bristol, Avon) 9(6):342–348. https://doi.org/10.1016/0268-0033(94)90063-9
Milne N (1991) The role of zygapophysial joint orientation and uncinate processes in controlling motion in the cervical spine. J Anat 178:189–201
Amevo B, Macintosh JE, Worth D, Bogduk N (1991) Instantaneous axes of rotation of the typical cervical motion segments: I. An empirical study of technical errors. Clin Biomech (Bristol, Avon) 6(1):31–37. https://doi.org/10.1016/0268-0033(91)90039-S
Liu B, Liu Z, VanHoof T, Kalala J, Zeng Z, Lin X (2014) Kinematic study of the relation between the instantaneous center of rotation and degenerative changes in the cervical intervertebral disc. Eur Spine J 23(11):2307–2313. https://doi.org/10.1007/s00586-014-3431-7
Walraevens J, Liu B, Meersschaert J, Demaerel P, Delye H, Depreitere B et al (2009) Qualitative and quantitative assessment of degeneration of cervical intervertebral discs and facet joints. Eur Spine J 18(3):358–369. https://doi.org/10.1007/s00586-008-0820-9
Xiong Y, Xu L, Bi LY, Yang JZ, Wang FX, Qu Y et al (2019) Dynamic fusion process in the anterior cervical discectomy and fusion with self-locking stand-alone cages. World Neurosurg 125:e678–e687. https://doi.org/10.1016/j.wneu.2019.01.152
Shin DA, Yi S, Yoon DH, Kim KN, Shin HC (2009) Artificial disc replacement combined with fusion versus two-level fusion in cervical two-level disc disease. Spine (Phila Pa 1976) 34(11):1153–1159. https://doi.org/10.1097/BRS.0b013e31819c9d39
Xiong Y, Xu L, Yu X, Yang Y, Zhao D, Hu Z et al (2018) Comparison of 6-year follow-up result of hybrid surgery and anterior cervical discectomy and fusion for the treatment of contiguous two-segment cervical degenerative disc diseases. Spine (Phila Pa 1976) 43(20):1418–1425. https://doi.org/10.1097/BRS.0000000000002639
Hey HW, Hong CC, Long AS, Hee HT (2013) Is hybrid surgery of the cervical spine a good balance between fusion and arthroplasty? Pilot results from a single surgeon series. Eur Spine J 22(1):116–122. https://doi.org/10.1007/s00586-012-2486-6
Ren X, Chu T, Jiang T, Wang W, Wang J, Li C et al (2016) Cervical disk replacement combined with cage fusion for the treatment of multilevel cervical disk herniation. Clin Spine Surg 29(6):218–225. https://doi.org/10.1097/BSD.0b013e31826994bb
Wang KF, Duan S, Zhu ZQ, Liu HY, Liu CJ, Xu S (2018) Clinical and radiologic features of 3 reconstructive procedures for the surgical management of patients with bilevel cervical degenerative disc disease at a minimum follow-up period of 5 years: a comparative study. World Neurosurg 113:e70–e76. https://doi.org/10.1016/j.wneu.2018.01.157
Liu B, Zeng Z, Hoof TV, Kalala JP, Liu Z, Wu B (2015) Comparison of hybrid constructs with 2-level artificial disc replacement and 2-level anterior cervical discectomy and fusion for surgical reconstruction of the cervical spine: a kinematic study in whole cadavers. Med Sci Monit 21:1031–1037. https://doi.org/10.12659/MSM.892712
Yu CC, Liu P, Huang DG, Jiang YH, Feng H, Hao DJ (2016) A new cervical artificial disc prosthesis based on physiological curvature of end plate: a finite element analysis. Spine J 16(11):1384–1391. https://doi.org/10.1016/j.spinee.2016.06.019
Lou J, Li Y, Wang B, Meng Y, Wu T, Liu H (2017) In vitro biomechanical comparison after fixed: and mobile-core artificial cervical disc replacement versus fusion. Medicine (Baltimore) 96(41):e8291. https://doi.org/10.1097/MD.0000000000008291
Lou J, Liu H, Rong X, Gong Q, Song Y, Li T (2015) Location change of rotation center after single segmental cervical disc replacement with ProDisc-C. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 29(1):48–53 (Chinese)
Mo Z, Zhao Y, Du C, Sun Y, Zhang M, Fan Y (2015) Does location of rotation center in artificial disc affect cervical biomechanics? Spine (Phila Pa 1976) 40(8):E469–E475. https://doi.org/10.1097/BRS.0000000000000818
DiAngelo DJ, Roberston JT, Metcalf NH, McVay BJ, Davis RC (2003) Biomechanical testing of an artificial cervical joint and an anterior cervical plate. J Spinal Disord Tech 16(4):314–323. https://doi.org/10.1097/00024720-200308000-00002
Ryu WH, Kowalczyk I, Duggal N (2013) Long-term kinematic analysis of cervical spine after single-level implantation of Bryan cervical disc prosthesis. Spine J 13(6):628–634. https://doi.org/10.1016/j.spinee.2013.02.046
Rong X, Gong Q, Liu H, Hong Y, Lou J, Wu W et al (2014) The effect of deviated center of rotation on flexion-extension range of motion after single-level cervical arthroplasty: an in vivo study. Spine (Phila Pa 1976) 39:B12–B18. https://doi.org/10.1097/BRS.0000000000000634
Rousseau MA, Cottin P, Levante S, Nogier A, Lazennec JY, Skalli W (2008) In vivo kinematics of two types of ball-and-socket cervical disc replacements in the sagittal plane: cranial versus caudal geometric center. Spine (Phila Pa 1976) 33(1):E6-9. https://doi.org/10.1097/BRS.0b013e31815e5dce
Lou J, Li H, Rong X, Wu W, Liu H (2016) Location change of center of rotation after single-level cervical total disc replacement with ProDisc-C. Acta Orthop Traumatol Turc 50(3):339–345. https://doi.org/10.3944/AOTT.2016.15.0182
Barrey C, Champain S, Campana S, Ramadan A, Perrin G, Skalli W (2012) Sagittal alignment and kinematics at instrumented and adjacent levels after total disc replacement in the cervical spine. Eur Spine J 21(8):1648–1659. https://doi.org/10.1007/s00586-012-2180-8
Koller H, Meier O, Zenner J, Mayer M, Hitzl W (2013) In vivo analysis of cervical kinematics after implantation of a minimally constrained cervical artificial disc replacement. Eur Spine J 22(4):747–758. https://doi.org/10.1007/s00586-012-2583-6
Zhang HX, Chen Y, Gao P, Shao YD, Hou Y, Cheng L et al (2014) Clinical and radiographic evaluation of cervical disk replacement: a retrospective study. Orthopedics 37(11):e956–e961. https://doi.org/10.3928/01477447-20141023-50
Lazaro BC, Yucesoy K, Yuksel KZ, Kowalczyk I, Rabin D, Fink M et al (2010) Effect of arthroplasty design on cervical spine kinematics: analysis of the bryan disc, ProDisc-C, and synergy disc. Neurosurg Focus 28(6):E6. https://doi.org/10.3171/2010.3.FOCUS1058
Li C, Yu X, Xiong Y, Yang Y, Wang F, Zhao H (2022) Analysis of mid- to long-term follow-up outcomes after anterior cervical Hybrid surgery for the treatment of adjacent two-level spondylosis. Chin J Spine Spin Cord 32(07):595–604
Kowalczyk I, Lazaro BC, Fink M, Rabin D, Duggal N (2011) Analysis of in vivo kinematics of 3 different cervical devices: bryan disc, ProDisc-C, and prestige LP disc. J Neurosurg Spine 15(6):630–635. https://doi.org/10.3171/2011.8.SPINE11273
Xiong Y, Yang YD, Yu X, Bi LY, Yang JZ, Wang FX et al (2020) Comparison of 2-year follow-up results of the hybrid surgery using Mobi-C combined with ROI-C and anterior cervical discectomy and fusion for the treatment of contiguous two-level cervical degenerative disc diseases. J Clin Neurosci 73:42–47. https://doi.org/10.1016/j.jocn.2020.01.090
Takami T, Hara T, Hara M, Inui T, Ito K, Koyanagi I, er al, (2022) Safety and validity of anterior cervical disc replacement for single-level cervical disc disease: initial two-year follow-up of the prospective observational post-marketing surveillance study for japanese patients. Neurol Med Chir (Tokyo) 62(11):489–501. https://doi.org/10.2176/jns-nmc.2022-0148
Kieser DC, Cawley DT, Fujishiro T, Mazas S, Boissière L, Obeid I et al (2018) Risk factors for anterior bone loss in cervical disc arthroplasty. J Neurosurg Spine 29(2):123–129. https://doi.org/10.3171/2018.1.SPINE171018
Ferguson SJ, Steffen T (2003) Biomechanics of the aging spine. Eur Spine J 12(Suppl 2 (Suppl 2)):S97–S103. https://doi.org/10.1007/s00586-003-0621-0
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In this paper, the research is sponsored by the Horizontal Subject “effect of biomimetic mineralized collagen artificial bone in the treatment of spinal diseases and fractures”.
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XY contributed to the research and design of this article. YM contributed to the first draft of the article. CL, YX, HZ, YY, DZ, FW, YQ, JY, LB, XY carried out literature search, quality evaluation, data collection and analysis. All authors agree to be accountable for all aspects of the work. All authors read and approved the final manuscript.
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Ma, Y., Yu, X., Li, C. et al. Changes in the centre of rotation and the anterior bone loss of the vertebral body in Mobi-C artificial disc replacement segments after cervical hybrid surgery: a retrospective study. Eur Spine J 33, 1265–1274 (2024). https://doi.org/10.1007/s00586-023-08047-y
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DOI: https://doi.org/10.1007/s00586-023-08047-y