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  • Title: Anterior Cervical Discectomy and Fusion Versus Hybrid Decompression and Fusion for the Treatment of 3-Level Cervical Spondylotic Myelopathy: A Comparative Analysis of Cervical Sagittal Balance and Outcomes.
    Author: Xu Z, Rao H, Zhang L, Li G, Xu Z, Xu W.
    Journal: World Neurosurg; 2019 Dec; 132():e752-e758. PubMed ID: 31415890.
    Abstract:
    OBJECTIVE: To compare the cervical sagittal balance and surgical outcomes between anterior cervical discectomy and fusion (ACDF) and hybrid decompression and fusion (HDF; 1-level corpectomy combined with 1-level discectomy) for consecutive 3-level cervical spondylotic myelopathy (CSM). METHODS: From January 2013 to June 2016, 82 patients with 3-level CSM who underwent ACDF (n = 40) and HDF (n = 42) were retrospectively reviewed. Perioperative parameters, clinical outcomes, and radiologic sagittal alignment were analyzed and compared. RESULTS: Patients were followed up for 35.5 ± 6.5 months (range, 25-53 months). All patients had achieved significant improvement in Neck Disability Index and Japanese Orthopedic Association scores after operation, with similar clinical outcomes between both groups (P > 0.05). In the ACDF group, 2 patients were found with axial symptoms, and 1 with hoarseness. In the HDF group, 5 patients were found with axial symptoms, 1 with hoarseness, 1 with dysphagia, and 1 with pseudarthrosis. The ACDF group had less operation time and bleeding compared with the HDF group (P < 0.05). The restoration of segmental and C2-7 lordosis were significantly greater in the ACDF group than the HDF group (P < 0.05). The C2-7 sagittal vertical axis and T1 slope minus C2-7 lordosis decreased in the ACDF group at final follow-up (P < 0.05); however, there was no obvious change in those of the HDF group (P > 0.05). CONCLUSIONS: Both ACDF and HDF were safe and effective for the treatment of 3-level CSM. ACDF showed superiority to HDF in terms of less blood loss, shorter operation time, and better postoperative sagittal balance.
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