Global Spine Journal - 2026-04-26 - Journal Article; Review
Is Motion Preservation With Three-Level Hybrid Cervical Surgery Achieved Without Compromising Clinical Outcomes? A Systematic Review and Meta-Analysis.
Viswanathan VK, Muthu S, Sampathkumar V, Kolarpatti Ponnusamy DV, Rajappan Chandra SK, Sharun K, Rajaram Manoharan SR, Theiss S
Topics
Key Takeaway
In three-level cervical degenerative disease, hybrid ACDF-CDA constructs and three-level ACDF produce equivalent NDI, VAS, and JOA improvements, with hybrid surgery showing a non-significant trend toward greater ROM preservation (P=0.06) across 1,008 patients.
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Summary
This systematic review and meta-analysis asked whether three-level hybrid ACDF-CDA constructs preserve motion without sacrificing clinical or safety outcomes compared to three-level ACDF. Twelve comparative studies were pooled using random-effects models. No significant between-group differences were found in NDI, VAS neck/arm, JOA, C2-C7 Cobb angle, fusion rates, or complication rates, though hybrid surgery trended toward greater ROM preservation (P=0.06) with moderate-to-high heterogeneity across several outcomes.
Key Limitation
Moderate-to-high heterogeneity across complication and ROM outcomes, combined with the predominantly retrospective design of included studies, limits confidence in the equivalence conclusions and introduces significant selection bias regarding which levels received arthroplasty versus fusion.
Original Abstract
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.