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J Korean Soc Spine Surg. 2017 Dec;24(4):211-220. Korean. Original Article.
Hyun YS , Park JS , Song KW , Kim GL , Lee JY , Shin JH .
Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital Kangdong Sacred Heart Hospital-affiliated to Hallym University College of Medicine, Seoul, Korea.

Study Design

Retrospective case-control study.


To compare the clinical and radiographic outcomes of a hybrid construct (HC) of cervical artificial disc replacement (CADR) combined with anterior cervical discectomy and fusion (ACDF) (group I) with 2-level ACDF (group II) in patients with 2-level cervical disc disease.

Summary of Literature Review

ACDF is reported to potentially promote degenerative changes in the adjacent segment. CADR has been expected to reduce the risk of adjacent segment degeneration. However, its clinical course has yet to be sufficiently clarified.

Materials and Methods

Twenty-six patients underwent 2-level cervical disc surgery. Single-level CADR combined with ACDF was performed in 14 patients. Twelve patients underwent 2-level ACDF. Clinical profiles were assessed using the neck disability index (NDI) and visual analogue scale scores of arm and neck pain. Dynamic lateral cervical radiographs were obtained preoperatively and at 1, 6, 12, and 18 months postoperatively. The range of motion (ROM) of the overall cervical spine (C2-7) and the adjacent segments was measured.


Group I showed superior NDI 18 months postoperatively (p < 0.05). The mean C2-7 ROM of both groups recovered to the preoperative ROM. At 18 months postoperatively, the C2-7 ROM of group I was higher than that of group II (p < 0.05). The superior adjacent segment ROM was higher in group II (p < 0.05), starting at 6 months. The inferior adjacent segment ROM showed no significant difference between the groups (p>0.05).


The HC group showed comparable clinical and radiographic outcomes to those of the 2-level ACDF group. HC can be used selectively in the treatment of patients with 2-level cervical disc disease.

Copyright © 2019. Korean Association of Medical Journal Editors.