Work

Three-Level Cervical Disc Arthroplasty Combined With Fusion Versus Three-Level ACDF: A Systematic Review and Meta-Analysis

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: Study Design Systematic Review. Objectives To compare clinical, radiological, and complication outcomes between three-level hybrid surgery [combining cervical disc arthroplasty (CDA) with anterior cervical discectomy and fusion (ACDF)] and three-level ACDF alone in patients with multilevel cervical degenerative disease. Methods A systematic review and meta-analysis were conducted following PRISMA guidelines. Nine retrospective cohort studies (704 patients: 450 HS, 254 ACDF) were included. Pooled mean differences (MD) with 95% confidence intervals (CI) were calculated for clinical, radiological, perioperative, and complication outcomes. Results Both HS and ACDF significantly improved disability and myelopathy scores, with no differences in NDI or mJOA. HS preserved better the operated-level ROM (MD + 5.79°; 95% CI 2.38 – 9.21; P = 0.0009), while adjacent segment motion did not differ. Arm pain improvement showed a non-significant trend favouring HS (MD –2.63; P = 0.08), and neck pain was similar. Both procedures improved segmental lordosis; global alignment remained stable. Complications differed: instrumentation failure was more common with ACDF (33.3% vs 5.2%, P = 0.02), while HO occurred in 41.2% of hybrid constructs, reflecting loss of arthroplasty motion. Conclusion Three-level HS and ACDF provide comparable clinical outcomes. HS is a promising alternative, providing better motion preservation but at the cost of a higher risk of heterotopic ossification, while ACDF may be associated with a higher rate of instrumentation failure. Long-term prospective studies are still needed to strengthen these conclusions.

Source: Global Spine Journal

DOI: 10.1177/21925682261424764

Authors: Chinedu Egu, Neel Badhe, Hussein Akil, Rebecca Aida Hakim, Elie Najjar, Balaji Purushothaman