Understanding Hybrid ACDF/CDR

Hybrid ACDF/CDR is a type of spine surgery that combines two different procedures: Anterior Cervical Discectomy and Fusion (ACDF) and Cervical Disc Replacement (CDR). The aim is to relieve pain, weakness, and/or numbness caused by a compressed nerve or spinal cord in your neck while preserving as much natural movement as possible.

ACDF vs. CDR

ACDF (Anterior Cervical Discectomy and Fusion): In this surgery, the damaged disc is removed and the adjacent vertebrae are fused together. While this stabilizes the spine, it results in reduced flexibility.

CDR (Cervical Disc Replacement): This procedure involves removing the damaged disc and replacing it with an artificial disc that mimics the natural movement of the spine, preserving motion.

Hybrid Approach: When multiple discs are damaged, the surgeon may choose to perform ACDF on one level and CDR on another—combining the stability of fusion with the flexibility of disc replacement.

Why Choose a Hybrid Approach?

• Best of Both Worlds: It combines the stability provided by ACDF with the motion preservation of CDR.
• Customized Treatment: Allows the surgeon to tailor the procedure based on the condition of each disc.
• Alternative to Multi-Level CDR: In regions where insurance coverage is limited, hybrid surgery offers a viable alternative.

Which Disc is Fused and Which is Replaced?

There is no one-size-fits-all answer. Typically, the disc that is more severely damaged, often with significant loss of height or associated arthritis, is chosen for fusion, while the other disc is replaced. Prof Aaron Buckland makes this decision based on a detailed preoperative evaluation.

Surgical Approach

The surgery is performed through a small (approximately 1-inch) incision at the front of the neck. The cervical spine is accessed by gently dissecting between the neck tissues without cutting them, allowing direct visualization of the affected discs.

• Removing the Damaged Discs: Under high-powered microscopic magnification, the damaged discs are removed to relieve nerve compression.
• Relieving Nerve Compression: The spinal cord and nerve roots are carefully freed from any compressive fragments or bone spurs.
• Inserting an Artificial Disc: For the level designated for replacement, an artificial disc made of durable metal and plastic is inserted to maintain natural movement.
• Inserting a Cage: At the fusion level, a spacer (cage) filled with bone graft is placed to maintain disc height and facilitate fusion between adjacent vertebrae.
• Securing with Plate and/or Screws: A low-profile plate and screws are used to secure the fused vertebrae and prevent any movement, ensuring stability.

A schematic representation of the hybrid surgical approach.

Recovery

After surgery, most patients spend one night in the hospital. Recovery times vary, but many experience immediate relief of nerve pain. Minor issues—such as difficulty swallowing and neck tightness—may persist for 3-4 weeks. A soft collar is typically provided for comfort, but patients are encouraged to move their neck as tolerated. Postoperative instructions include avoiding strenuous activities, such as lifting and overhead movements, until healing is complete.

Summary

Hybrid ACDF/CDR offers a balanced approach by combining the stability of fusion with the motion-preserving benefits of disc replacement. This technique is ideal for patients with multi-level disc pathology, and it aims to provide effective pain relief, improved function, and a quicker recovery. Discuss your options with Prof Aaron Buckland to determine the best treatment approach for your condition.