This disc disease will cause neck and arm pain, tingling, weakness, and other symptoms. However, since the disease affects more than one level of the cervical spine, multiple spinal fusions or multiple artificial disc replacements may not be the right approach. In many cases, hybrid cervical spine surgery is the best solution.
Hybrid cervical spine surgery is a single spine surgery of the neck that combines two procedures: anterior cervical discectomy and fusion (ACDF) and artificial disc replacement. Hybrid cervical spine surgery is performed on patients who have degenerative disc disease, cervical disc herniation, and/or cervical spinal stenosis in two or more levels of the cervical spine.
Surgeons practice hybrid cervical spine surgeries because they are an ideal choice for a specific group of patients.
Surgeons usually offer hybrid cervical spine surgeries to patients who have:
Diseased discs or spinal problems that cause symptoms at two or more cervical spine levels.
At least one level of the spine that cannot be treated with artificial disc replacement.
At least one level of the spine that can be treated with artificial disc replacement.
A desire to have good range of motion in the neck after spine surgery.
If spine surgeons perform spinal fusion at every cervical spine level that causes symptoms, it would likely leave the neck relatively stiff and immobile. On the other hand, artificial disc replacement may not be possible at every cervical spine level that causes symptoms. Therefore, surgeons practice hybrid cervical surgeries to provide the greatest possible benefit of both spine surgery procedures.
The benefits of hybrid cervical procedures can be very technical:
“The benefit of cervical hybrid surgery is preservation of motion through the construct, while still offering appropriate treatment at levels contraindicated for arthroplasty. Motion preservation allows load sharing, which provides a more favorable biomechanical environment at adjacent segments compared with that afforded by fusion surgery, thereby reducing the compensatory hypermobility and peak stresses that would otherwise accelerate the processes of radiologic adjacent segment pathology (RASP) and subsequent clinical adjacent segment pathology (CASP).”
Stated more simply, the benefits of hybrid cervical procedures are:
Better range of motion in the neck than if fusion was performed at all levels.
More evenly distributed forces along the spine (e.g., the weight of the head, bending and turning of the neck), which protects other levels of the spine and surrounding structures from damage.
Effective treatment for cervical spine levels that cannot be treated with artificial disc replacement
In essence, hybrid cervical surgery relieves pain, tingling, numbness, and weakness; provides patients with better spinal range of motion than multilevel fusion; and can help to protect the spine from future damage and disease compared to multilevel fusion.
The clinical results of hybrid cervical surgery seem to be very favorable. In a recently published clinical study, 151 patients with spine disease at two, three, or four levels of the cervical spine were treated with hybrid cervical surgery and followed for several years to monitor their progress and satisfaction. Patients also had signs of disease visible on imaging studies and at least some radiculopathy (weakness, numbness in an arm caused by nerve root dysfunction) demonstrated by electromyography studies.
Results of the clinical study clearly show hybrid cervical surgery reduced patient-reported pain in the neck and in the affected arm as early as three months after surgery (the first timepoint in the study). Also, neck disability was lower. In all three cases, the results were statistically significant, but also exceeded the minimum clinically important difference or MCID. MCID is the amount of improvement on patient-reported scales that actually matters to patients. In other words, hybrid cervical surgery reduced arm pain, reduced neck pain, and reduced neck disability to an extent that patients deemed important and worthwhile to them. A large majority of patients (88.3%) rated their satisfaction as either “good” or “excellent” three months after surgery and reported similar levels of satisfaction over the next 10 years.
The authors of the study concluded, “Cervical hybrid surgery for cervical [multilevel degenerative disc disease] demonstrates favorable and sustained clinical outcomes at short-term to midterm follow up.”
If you are a candidate for hybrid cervical surgery, it is probably your best option. Hybrid cervical surgery provides the benefits of fusion and artificial disc replacement on the individual spinal levels that need it.
Recovery after hybrid cervical surgery is quite similar to recovery after anterior cervical discectomy and fusion (ACDF). That is because recovery times after fusion are a bit longer than for artificial disc replacement. Therefore, the levels treated with artificial disc replacement will heal a bit faster than the levels treated with fusion.
No. Patients tend to stay in the surgery center facility about the same time (a few hours) whether the procedure is a hybrid cervical surgery or a disc replacement.
After you are placed under general anesthesia by an anesthesiologist, your spine surgeon will make a small incision in the front of your neck. The surgeon will gently move the structures in your neck aside to get a clear view of the diseased spine levels. Each damaged disc, including any pieces that are pinching nerves roots or the spinal cord, will be carefully removed. If the spinal level is destined to have a spinal fusion, a bit of bone or bone-like substance will be placed between the two spinal bones. If the spinal level is slated to have a replacement disc, a cervical artificial disc will be placed in the space between the spinal bones in the neck. Vital structures in the neck are then returned to their normal position, and the surgical wound is then closed.
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