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Objective: Very few studies researched the treatment modalities in treating degenerative disc disease for two adjacent levels of the cervical spine. In order to reduce distress on the adjacent segments and minimize implant subsidence we analyzed the use of a hybrid approach combining arthroplasty with cage fusion. Methods: 64 “fusion-only” and 47 hybrid patients between the age of 30 and 60 years were clinically evaluated using ODI, Odon’s criteria. X-rays in two planes of the cervical spine were taken, measuring alpha and C2-C7 beta angles using Harrison’s tangent. Signs of subsidence in the sagittal plane were recorded, where subsidence was defined as a shift by more than 40% of the respective implant height.  Results: 10 cages combined with arthroplasty and 2 prostheses showed signs of subsidence compared to 47 cages in the fusion group (25 singe level and 11 on two levels). Overall subsidence after two years was found in 49% of the fusion group opposing 18% in our arthroplasty group. Patients with subsidence showed a longer recovery time to work, 14 weeks vs. 26, p=0.21; compared to the fusion group, 13/22 weeks, p=0.34. Odon’s criteria and Oswestry results were favorable and comparable in both groups. Revision rates were higher for arthroplasty 10.6% vs. 3.1%. Conclusion: We found two level ACDF implants to subside more frequently than in ACDF in combination with arthroplasty, indicating a reduced distress in the arthroplasty group. Absence of subsidence may have led to a faster return to work as may the implementation of arthroplasty. Overall the clinical outcome of both groups was comparable. However with the hybrid approach a higher revision rate occurred.

Comparison of Dual Level Fusion and Hybrid Treatment in the Cervical Spine Based on Patient Outcome