Clinical Outcomes and Complication Rates for Noncontiguous Anterior Cervical Discectomy and Fusion, Cervical Disc Arthroplasty, and Hybrid Cervical Surgery: A Systematic Review.

OBJECTIVE

This study examined clinical outcomes associated with 3 types of noncontiguous cervical surgeries - anterior cervical discectomy and fusion (ACDF), cervical disc arthroplasty (CDA), and hybrid cervical surgery (HCS) - to improve surgeon decision-making.

METHODS

A systematic review was performed using PubMed, CINAHL, MEDLINE, and Web of Science from database inception until June 6th, 2023. Inclusion criteria were studies that reported any type of clinical outcome, examined noncontiguous ACDF, noncontiguous CDA, and/or noncontiguous HCS.

RESULTS

Ten articles out of 523 articles initially retrieved were included. Patients (n = 388) had a mean age of 52 ± 5.1 years and a mean follow up time of 33 ± 6.0 months. Overall, 119 patients underwent non-contiguous HCS, 65 underwent non-contiguous CDA, and 204 underwent non-contiguous ACDF. There appears to be no clinically meaningful difference in Neck Disability Index (NDI) score, Japanese Orthopedic Association (JOA) score, and improvement in pain based on surgery type. There was a total of 83 complications (21% of cases) with non-contiguous ACDF having a higher absolute rate of dysphagia (20%) as compared to non-contiguous HCS (6.7%) or non-contiguous CDA (6.2%). Non-contiguous ACDF had a higher absolute rate of adjacent segment degeneration (ASD) as a reported complication (6.4%) as compared to non-contiguous HCS (1.7%) and non-contiguous CDA (0.0%).

CONCLUSIONS

There may be no clinically meaningful difference in many clinical outcomes for different non-contiguous surgical interventions for non-contiguous cervical degenerative disc disease (CDDD). However, complication rates, such as dysphagia and ASD, appear higher for non-contiguous ACDF as compared to non-contiguous CDA or HCS.