Custom Neck Surgery: Combining Spinal Fusion and Disc Replacement

It is common for patients to have more than one level of the disc in the neck (cervical spine) wear out. When multiple levels need to be included in the surgical plan, the traditional surgical approach in the past has been to fuse each level. Taking away the motion at two or more consecutive levels with a multilevel fusion can reduce the overall neck range of motion and is expected to put extra stress on the remaining non-fused disc levels. Cervical disc replacement is effective, and proven, option to preserve motion; however, this may not be suitable for patients with symptomatic multilevel cervical disc degeneration given its relatively narrow indication to be performed at 1 or 2 levels. 

 A hybrid surgery is a combination of spinal fusion and disc replacement. In this surgical plan, the most collapsed, stiff level is fused and the level with motion is replaced. Often times the lowest level or levels are treated with a spinal fusion and the upper level is treated with a disc replacement.  

This combination of ACDF (fusion) and ACDR (replacement) has been increasingly utilized over fusion alone for patients with symptomatic multilevel disc degeneration. Hybrid surgery aims to preserve as much segmental motion as possible while minimizing stress to the surrounding levels. 

Challenges do exist with coverage for hybrid surgery by some insurance companies, which may limit access to this option for some patients or increase the out-of-pocket costs to others. It is important to understand the surgical options through a detailed conversation with your surgeon. Through further research proving the benefits of cervical hybrid surgery, we are hopeful that this combination option becomes accessible to all patients.

References 

1. Cho BY, Lim J, Sim HB, Park J. Biomechanical analysis of the range of motion after placement of a two-level cervical ProDisc-C  versus hybrid construct. Spine. 2010;35:1769-1776. 
2. Lu VM, Zhang L, Scherman DB, Rao PJ, Mobbs RJ, Phan K. Treating multi-level cervical disc disease with hybrid surgery  compared to anterior cervical discectomy and fusion: a systematic review and meta-analysis. European spine journal : official  publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical  Spine Research Society. 2017;26:546-557.