Artificial Disk Replacement Combined With Fusion Versus 2-Level Fusion in Cervical 2-Level Disk Disease With a 5-Year Follow-up

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Study Design:

Prospective study.


The purpose of this study was to compare the long-term clinical and radiologic outcomes of hybrid surgery (HS) and 2-level anterior cervical discectomy and fusion (2-ACDF) in patients with 2-level cervical disk disease.

Summary of Background Data:

In a previous study with a 2-year follow-up, HS was shown to be superior to 2-ACDF, with a better Neck Disability Index (NDI) score, less postoperative neck pain, faster C2–C7 range of motion (ROM) recovery, and less adjacent ROM increase.

Materials and Methods:

Between 2004 and 2006, 40 patients undergoing 2-level cervical disk surgery at our hospital were identified as 2-level degenerative disk disease. Forty patients were included in the previous study; 35 patients were followed up for 5 years. Patients completed the NDI and graded their pain intensity before surgery and at routine postoperative until 5 years. Dynamic cervical radiographs were obtained before surgery and at routine postoperative intervals and the angular ROM for C2–C7 and adjacent segments was measured.


The HS group had better NDI recovery until 3 years after surgery (P<0.05). Postoperative neck pain was lower in the HS group at 1 and 3 years after surgery (P<0.05), but arm pain relief was not differently relieved. The HS group showed more angular ROM for C2–C7 at 2 and 3 years after surgery. The superior adjacent segment ROM showed hypermobility in the 2-ACDF group and hypomobility in the HS group at all follow-up periods without statistically significance, but the inferior adjacent segment ROM differed significantly (P<0.05).


HS is superior to 2-ACDF; it leads to better NDI recovery, less postoperative neck pain, faster C2–C7 ROM recovery, and less adjacent ROM increase over a 2-year follow-up, but these benefits of HS become similar to those of 2-ACDF with 5 years of follow-up.

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