Surgical Technique for TDR/ACDF Hybrid Constructs: A Surgical Video Case Example

Anterior cervical discectomy and fusion (ACDF) is the gold standard approach for surgical management of many manifestations of cervical spine pathology. In recent years, total disc replacement (TDR) has emerged as a motion preserving modality that is proposed to decrease the rate of adjacent segment disease (ASD). In patients with multi-level disease, hybrid constructs with ACDF at 1 level and TDR at an adjacent level have been performed with success. While these contiguous hybrid constructs have been shown to reduce rates of ASD, there is a paucity of literature regarding non-contiguous hybrid constructs.^1-3 When performing anterior cervical surgery with the intention of completing an ACDF and a TDR at non-contiguous levels, there are multiple unique technical aspects of the exposure and discectomy that must be taken into consideration. Here we present a technique report of a 59-year-old male patient who had non-contiguous cervical spondylosis who underwent a successful C2/C3 ACDF and C4/C5 and C5/C6 TDR. Multiple surgical options were discussed with the patient including multi-level anterior fusion, posterior laminoplasty, and posterior decompression and fusion.^4-6 Following discussion of risks, benefits, and alternatives, the patient consented to the anterior hybrid approach. The patient underwent an uncomplicated hybrid anterior fusion and disc arthroplasty and was discharged home on postoperative day 1. The present video serves as technique guide and case study of a non-contiguous construct with satisfactory motion preservation and clinical outcome (Video 1).