Treating multi-level cervical disc disease with hybrid surgery compared to anterior cervical discectomy and fusion: a systematic review and meta-analysis

Victor M. Lu*, Lucy Zhang, Daniel B. Scherman, Prashanth J. Rao, Ralph J. Mobbs, Kevin Phan

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

28 Citations (Scopus)


Purpose: The traditional surgical approach to treat multi-level cervical disc disease (mCDD) has been anterior cervical discectomy and fusion (ACDF). There has been recent development of other surgical approaches to further improve clinical outcomes. Collectively, when elements of these different approaches are combined in surgery, it is known as hybrid surgery (HS) which remains a novel treatment option. A systematic review and meta-analysis was conducted to compare the outcomes of HS versus ACDF for the treatment of mCDD. Methods: Relevant articles were identified from six electronic databases from their inception to January 2016. Results: From 8 relevant studies identified, 169 patients undergoing HS were compared with 193 ACDF procedures. Operative time was greater after HS by 42 min (p < 0.00001), with less intraoperative blood loss by 26 mL (p < 0.00001) and shorter return to work by 32 days (p < 0.00001). In terms of clinical outcomes, HS was associated with greater C2–C7 range of motion (ROM) preservation (< 0.00001) and less functional impairment (p = 0.008) after surgery compared to ACDF. There was no significant difference between HS and ACDF with respect to postoperative pain (p = 0.12). The postoperative course following HS was not significantly different to ACDF in terms of length of stay (p = 0.24) and postoperative complication rates (p = 0.18). Conclusions: HS is a novel surgical approach to treat mCDD, associated with a greater operative time, less intraoperative blood loss and comparable if not superior clinical outcomes compared to ACDF. While it remains a viable consideration, there is a lack of robust clinical evidence in the literature. Future large prospective registries and randomised trials are warranted to validate the findings of this study.

Original languageEnglish
Pages (from-to)546-557
Number of pages12
JournalEuropean Spine Journal
Issue number2
Publication statusPublished - Feb 2017
Externally publishedYes


  • anterior cervical discectomy and fusion
  • hybrid surgery
  • artificial disc replacement
  • arthroplasty
  • anterior cervical corpectomy and fusion
  • cervical disc disease
  • multi-level
  • range of motion
  • systematic review
  • spine


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