Endoscope-assisted vs. conventional anterior cervical discectomy and fusion for single-level degenerative cervical disease: a systematic review and meta-analysis

Background Endoscope-assisted anterior cervical discectomy and fusion (EA-ACDF) has been introduced as a modified technique for the treatment of degenerative cervical disease, but its comparative efficacy and safety relative to conventional ACDF (CA-ACDF) remain uncertain. This systematic review and meta-analysis aimed to compare EA-ACDF with CA-ACDF for single-level degenerative cervical disease. Methods PubMed, Embase, Web of Science, the Cochrane Library, CNKI, WanFang, VIP, and SinoMed were searched from inception through September 7, 2026. Comparative studies of EA-ACDF vs. CA-ACDF were included. Random-effects meta-analyses were performed. Methodological quality was assessed using the Newcastle–Ottawa Scale, and certainty of evidence was evaluated using GRADE. Results Eleven retrospective comparative studies involving 755 patients were included. Compared with CA-ACDF, EA-ACDF was associated with longer operative time (MD = 17.31 min, 95% CI 11.38–23.23), but lower intraoperative blood loss (MD = −17.31 mL, 95% CI −24.38 to −10.25), postoperative drainage volume (MD = −10.97 mL, 95% CI −16.98 to −4.96), length of hospital stay (MD = −0.67 days, 95% CI −1.16 to −0.17), and overall complication rate (RR = 0.44, 95% CI 0.25–0.78). No significant between-group differences were observed in final Japanese Orthopaedic Association score, Neck Disability Index, visual analogue scale score, cervical lordosis, or fusion rate. The certainty of evidence ranged from low to very low. Conclusion EA-ACDF may offer modest perioperative advantages at the cost of longer operative time, while short- to mid-term clinical, radiographic, and fusion outcomes appear broadly similar. Current evidence does not establish clinical superiority. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251123475 , identifier CRD420251123475.