XXXX and total disc replacement versus 2-level circumferential fusion with @entity2649 : a prospective, randomized, clinical and radiological trial.

@entity1 @entity2649 @entity1347 @entity1515 @entity179 @entity130
STUDY DESIGN: Prospective, randomized trial. PURPOSE: The treatment of @entity179 ( @entity179 ) with two-level fusion has been associated with a reasonable rate of complications. The aim of the present study was to compare (Hybrid) stand-alone @entity1347 ( @entity1347 ) at L5/S1 with total disc replacement at L4/5 (TDR) as an alternative surgical strategy to (Fusion) 2-level circumferential fusion employing @entity2649 ( @entity2649 ) with transpedicular stabilization at L4-S1. METHODS: A total of 62 @entity1 with symptomatic @entity179 of segments L5/S1 (Modic >= 2  ) and L4/5 (Modic  <=2  ; positive discography) were enrolled; 31 were treated with Hybrid and 31 with Fusion. Preoperatively, at 0, 12, and a mean follow-up of 37  months, clinical (ODI, VAS) and radiological evaluations (plain/extension-flexion radiographs evaluated for implant failure, fusion, global and segmental @entity1515 , and ROM) were performed. RESULTS: In 26 of 31 Hybrid and 24 of 31 Fusion @entity1 available at the final follow-up, we found a significant clinical improvement compared to preoperatively. Hybrid @entity1 had significantly lower VAS scores immediately postoperatively and at follow-up compared to Fusion @entity1 . The complication rates were low and similar between the groups. Lumbar @entity1515 increased in both groups. The increase was mainly located at L4-S1 in the Hybrid group and at L1-L4 in the Fusion group. Hybrid @entity1 presented with increased ROM at L4/5 and L3/4, and Fusion @entity1 presented with increased ROM at L3/4, with significantly greater ROM at L3/4 compared to Hybrid @entity1 at follow-up. CONCLUSIONS: Hybrid surgery is a viable surgical alternative for the presented indication. Approach-related inferior @entity130 and the balanced @entity1515 resulted in superior clinical outcomes compared to two-level circumferential fusion with @entity2649 .
