Related Experiment Video
Updated: Sep 24, 2026
Multilevel Oblique Lumbar Interbody Fusion in Degenerative Lumbar Disc Disease with Instability
Published on: July 25, 2025
ACDF vs PCDF vs Laminoplasty for Multilevel Cervical Myelopathy: A Systematic Review and Meta-Analysis
Siddharth Jasti1, Tasif Mahmoud, Zvipo M Chisango
1Department of Orthopedics, Brown University, Providence, RI.
Study Design:
Systematic review and meta-analysis.
Objective:
To compare functional, radiographic, and complication outcomes among ACDF, PCDF, and laminoplasty for multilevel cervical spondylotic myelopathy (CSM).
Summary Of Background Data:
CSM is a major source of patient morbidity in the United States. Three surgical approaches are commonly employed for this degeneration: ACDF, PCDF, and laminoplasty. Comparative data is warranted to guide approach selection.
Methods:
In accordance with PRISMA guidelines, PubMed, Embase, CENTRAL, and Scopus were searched through February 2026 to identify comparative studies reporting outcomes among adult patients undergoing ACDF, PCDF, or laminoplasty for multilevel (≥3 levels) CSM. Twelve studies comprising 1,129 patients met inclusion criteria and were organized into three pairwise comparisons: ACDF versus laminoplasty, PCDF versus laminoplasty, and ACDF versus PCDF. Functional, radiographic, and complication outcomes were comparatively assessed. Continuous outcomes were pooled as mean differences (MD) with 95% confidence intervals (CI). Dichotomous outcomes were pooled as odds ratios (OR) with 95% CI. Heterogeneity was assessed using the I² statistic.
Results:
JOA score improvement did not differ between ACDF and laminoplasty (MD=-0.20, P=0.43) or ACDF and PCDF (MD=1.06, P=0.21). VAS neck pain favored ACDF over laminoplasty (MD=-1.05, P=0.03). ACDF demonstrated reduced cervical range of motion (MD=-9.14°, P<0.001) compared with laminoplasty. Hospital stay was shorter after ACDF (MD=-2.62 days, P=0.002) and longer after PCDF (MD=1.19 days, P<0.001) relative to laminoplasty. ACDF was associated with lower rates of axial pain (Peto OR=0.21, P=0.007) and C5 palsy (Peto OR=0.27, P=0.049) but higher rates of dysphagia (Peto OR=5.88, P<0.001) compared with laminoplasty. SSI was more frequent after PCDF than laminoplasty (Peto OR=4.27, P=0.01).
Conclusions:
ACDF, PCDF, and laminoplasty demonstrated similar neurological recovery for multilevel CSM. Procedure-specific differences in cervical range of motion, length of stay, and complication profiles support approach selection guided by preoperative alignment and patient-specific concerns.
