Hybrid cervical surgery has nearly two decades of clinical evidence behind it, even though several commercial payers still classify the technique as experimental or investigational to deny coverage, according to an article in the fall 2026 issue of Vertebral Columns.
The article was authored by Brandon Hirsch, MD, of Disc Sports and Spine Centers in Newport Beach, Calif.
Hybrid surgery combines cervical disc arthroplasty at one level with anterior cervical discectomy and fusion at an adjacent level, so each segment can be treated according to its pathology. The technique was first reported in 2009. Cervical disc replacement has grown rapidly since then: single-level arthroplasty volume in the Medicare population rose more than 1,400% between 2009 and 2022, according to data Dr. Hirsch cited.
Dr. Hirsch said the evidence base now includes cohorts followed for nearly 12 years, meta-analyses of up to 861 patients and a propensity-matched claims analysis. Pain, function and disability scores improved comparably after hybrid surgery and multilevel ACDF. In a claims cohort of 430 hybrid patients and 2,136 multilevel fusion patients, hybrid surgery did not increase the risk of subsequent surgery. In the largest single-center dataset, which included 376 patients, fusion rates at the treated level were 98.8% to 100% in the hybrid groups, compared with 91.9% after two-level ACDF.
No study found a significantly higher complication rate after hybrid surgery, according to the article. One single-surgeon series of 66 patients found less dysphagia at six months after hybrid surgery than after ACDF (8.7% versus 32.6%).
Dr. Hirsch acknowledged that the literature is predominantly observational. Meta-analyses were split on whether hybrid surgery reduces adjacent segment degeneration, a discrepancy he attributed to shorter follow-up in earlier analyses, since degeneration accumulates over time. Few studies tracked reoperation as a discrete endpoint; only three of the 20 studies in the largest meta-analysis recorded it.
Still, no analysis has identified a safety signal specific to the construct, Dr. Hirsch said. With a body of literature spanning more than 3,000 patients and more than a decade of follow-up, he concluded the technique is “far from experimental.”
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