Study design Retrospective cohort study. Objective To perform a retrospective study comparing 2 level hybrid surgery (1 level ACDF and 1 level CDR) with 2 level ACDF and 2 level CDR. Methods Patients undergoing first-instance two-level cervical spine surgery were identified using CPT codes and grouped into ACDF, CDR, or hybrid (single-level ACDF + single-level CDR) cohorts, with exclusions for posterior fusion, trauma, infection, malignancy, prior revision, and overlapping procedures. Revision surgery was defined as any cervical operation within two years of the index procedure, and baseline variables included demographics, comorbidities (Elixhauser Comorbidity Index), cervical pathology, insurance type, tobacco history and osteoporosis. Comparisons were performed using t-tests and chi-square tests, and adjusted Cox proportional hazards models and Kaplan–Meier analysis were used to evaluate two-year revision risk and revision-free survival among cohorts. Result Among 122,164 patients, ACDF patients were older and had greater comorbidity burden and higher rates of myelopathy and osteoporosis, with overall secondary cervical procedures most frequent after two-level ACDF. On multivariable analysis, myelopathy, tobacco history and osteoporosis were independently associated with increased revision risk, while insurance status was not. Surgical approach (ACDF, CDR, or hybrid) was not independently associated with two-year revision risk, and Kaplan–Meier analysis showed no significant differences in revision-free survival among cohorts. Conclusion Surgical approach (ACDF, CDR, or hybrid) was not independently associated with differences in two-year revision risk.
Issani et al. (2026) studied this question.