Safety and Outcome of Outpatient 2-Level Hybrid Anterior Cervical Discectomy and Fusion plus Adjacent Total Disc Replacement

Objective: The emergence of modern technologies and surgical techniques has challenged anterior cervical discectomy and fusion (ACDF) as the gold-standard treatment for cervical spondylosis. In an effort to reduce fusion levels and preserve mobility, combining ACDF and total disc replacement (TDR) has been explored in the literature. No reports were found which investigated the feasibility of this hybrid procedure in an ambulatory surgery centre (ASC). The authors aim to determine the feasibility of performing combined ACDF with TDR in an ASC. Methods: We evaluated medical records of 15 consecutive patients, who presented with multilevel cervical degenerative disc disease. Single-stage instrumented ACDF with concurrent cervical TDR was performed in an ASC. Outcome measures examined were visual analogue scale (VAS) scores for neck pain, neck disability index (NDI), nurick grade, quality of life assessment (QoL) through the physical and mental composite scores (PCS and MCS) of the Short-Form 12 (SF-12) health survey and complications. Outpatient spine surgery protocols and guidelines are provided. Results: Males accounted for 70% of the patient population with overall mean age of 45.13 +/- 1.9 years with mean body mass index (BMI) of 28.2 +/- 8.5 kg/m(2). Minimum follow-up was 12 months. Estimated blood loss was 71 +/- 23 milliliters and mean operating time was 45 minutes. Clinically significant improvement was achieved in 80% of patients with mean VAS score for neck pain of 8.4 +/- 0.8 reducing to 4.5 +/- 1.2, which was statistically significant (p = 0.043). Similarly, pre-operative mean NDI of 55 +/- 7% reduced to 33 +/- 9% postoperatively (p = 0.03). Nurick grades were 0 in each patient by final follow-up and there were no complications reported. Overall improvement in QoL was also accomplished. Conclusion: Combined ACDF and TDR can be safely done in an ASC with satisfactory clinical and patient-reported outcomes.