Study designSystematic review and meta-analysis.ObjectiveTo compare the clinical, radiographic, fusion and complication outcomes between three-level anterior cervical discectomy and fusion (ACDF) and hybrid constructs combining ACDF and cervical disc arthroplasty (CDA).MethodsSystematic search of PubMed, Embase, Scopus, and Web of Science was performed in accordance with PRISMA guidelines. Comparative studies evaluating three-level ACDF and three-level hybrid surgery were included. Primary outcomes included neck disability index(NDI), visual analogue scale(VAS) scores, Japanese Orthopaedic Association (JOA) scores, C2-C7 Cobb angle, C2-7 range of motion (ROM), fusion rates, and complications. Random-effects meta-analyses were performed. Heterogeneity and publication bias were assessed using standard statistical methods.ResultsTwelve studies comprising 1008 patients (553 hybrid and 455 ACDF) met the inclusion criteria. Both surgical strategies demonstrated significant improvements in NDI (P = 0.62), VAS neck (P = 0.40), arm(P = 0.70), and JOA (P = 0.97) scores, with no significant between-group differences across clinical outcomes. Hybrid constructs maintained ROM (P = 0.06), and cervical lordosis (P = 0.93) comparable to ACDF. Fusion rates at intended arthrodesis levels were high and similar in both cohorts. There were no significant differences in total, early or late complication rates, although heterogeneity was moderate to high across several outcomes.ConclusionIn three-level cervical degenerative disease, hybrid surgery and ACDF provide equivalent improvements in pain, disability, neurological recovery, alignment, fusion success, and complication profiles. Hybrid constructs demonstrated a trend towards greater preservation cervical range of motion without compromising clinical efficacy or safety. These findings support hybrid surgery as a selective, motion-preserving alternative to three-level ACDF in appropriately chosen patients.Level of evidenceII.
Viswanathan et al. (Sun,) studied this question.