Correction and Maintenance of Cervical Alignment: 3-Level ACDF Versus Corpectomy-ACDF "Hybrid" Procedures

Area of Science:

• Spine surgery
• Orthopedics
• Neurosurgery

Background:

• Anterior Cervical Discectomy and Fusion (ACDF), Anterior Cervical Corpectomy and Fusion (ACCF), and hybrid procedures are common for cervical spondylosis.
• Limited comparative data exists for 3-level ACDF versus hybrid procedures.

Purpose of the Study:

• To compare radiographic sagittal parameters and patient-reported outcomes (PROs) at 3 and 12 months.
• The study focused on patients undergoing 3-level ACDF or a hybrid procedure.

Main Methods:

• Longitudinal observational study comparing two cohorts: 3-level ACDF (N=47) and hybrid (N=52).
• Collected demographic, surgical, PROs, and radiographic data (C2PL, CL, SL, T1S) pre- and post-operatively.
• Follow-up included 3-month and 12-month assessments.

Main Results:

• Three-level ACDF showed significantly greater C2-C7 lordosis (CL) and segmental lordosis (SL) at 3 months, with CL maintained at 12 months.
• No significant differences in PROs were observed between the groups at any time point.
• The hybrid group required significantly more revision surgeries (6 vs. 1) within the 1-year study period (P < 0.001).

Conclusions:

• Three-level ACDF achieved superior postoperative cervical lordosis compared to hybrid procedures, with sustained cervical lordosis at 1 year.
• Despite similar patient-reported outcomes, hybrid procedures were associated with a higher rate of revision surgery.
• These findings suggest potential advantages of 3-level ACDF over hybrid procedures in maintaining sagittal alignment and reducing revision rates.