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Scott-Young, M., McEntee, L., Schram, B., Rathbone, E., Hing, W., & Nielsen, D. (2017, in press). The concurrent use of lumbar total disc arthroplasty and anterior lumbar interbody fusion: The lumbar hybrid procedure for the treatment of multi-level symptomatic degenerative disc disease a prospective study. Spine. doi: 10.1097/BRS.0000000000002263

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This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.





A prospective study.


The aim of this paper is to evaluate clinical and patient outcomes post combined Total Disc Arthroplasty (TDA) and Anterior Lumbar Interbody Fusion (ALIF), known as hybrid surgery for the treatment of multi-level symptomatic degenerative disc disease (DDD).


Class I studies comparing the treatment of one level lumbar DDD with TDA and ALIF have confirmed the effectiveness of those treatments through clinical and patient outcomes. While the success of single level disease is well documented, the evidence relating to the treatment of multi-level DDD with these modalities is emerging. With the evolution of the TDA technology, a combined approach to multi-level disease has developed in the form of the hybrid procedure.


A total of 617 patients underwent hybrid surgery for chronic back pain between July 1998 and February 2012. Visual Analog Pain Scale (VAS) for the back and leg were recorded along with the Oswestry Disability Index (ODI) and Roland Morris Disability Questionnaire (RMDQ).


Both statistically and clinically significant (p < 0.005) reductions were seen in back and leg pain, which was sustained for at least 8 years post-surgery. In addition, significant improvements (p < 0.001) in self-rated disability and function were also maintained for at least 8 years. Patient satisfaction was rated at good or excellent in over 90% of cases.


The results of this research indicate that improvements in both back and leg pain and function can be achieved using the hybrid lumbar reconstructive technique.


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