Comparison of Anterior Cervical Discectomy and Fusion (ACDF) and Posterior Endoscopic Cervical Decompression (PECD) for Single-Level Degenerative Cervical Disease: An Updated Meta-Analysis

Systematic review and meta-analysis.Objectives: To systematically compare the clinical efficacy and safety of posterior endoscopic cervical decompression (PECD) and anterior cervical discectomy and fusion (ACDF) for single-level degenerative cervical disease.Summary of Literature Review: ACDF has long been the standard surgical treatment for cervical radiculopathy, but it is associated with loss of motion and approach-related morbidity.Recent studies suggest that PECD techniques may provide comparable clinical outcomes while preserving motion; however, a comprehensive comparison of efficacy and safety is needed.Materials and Methods: PubMed, Embase, Scopus, and the Cochrane Library were systematically searched for studies published from January 2000 to May 2025.Randomized controlled trials and comparative cohort studies comparing ACDF with PECD for single-level degenerative cervical disease were included.Data on operative time, blood loss, hospital stay, visual analog scale (VAS) scores, Neck Disability Index (NDI) scores, and complication rates were extracted and analyzed using Review Manager (RevMan) 5.4.Results: Eleven studies involving 1,174 patients were included, comprising 599 patients treated with ACDF and 575 treated with PECD.Compared with ACDF, PECD was associated with significantly lower intraoperative blood loss (mean difference [MD]=35.65,p=0.02) and a shorter hospital stay (MD=1.60,p=0.004).Operative time did not differ significantly between the two groups (p=0.97).Both techniques achieved comparable long-term improvements in VAS scores for neck and arm pain and in NDI scores (p>0.05).The overall complication rate was significantly lower in the PECD group (odds ratio=2.00,p=0.001).Conclusions: PECD may be a safe and effective alternative to ACDF for appropriately selected patients with single-level degenerative cervical disease.Although both procedures provide comparable long-term pain relief and functional improvement, PECD is associated with less blood loss, shorter hospitalization, and fewer complications.