The following is a summary of “Correction and Maintenance of Cervical Alignment 3-Level ACDF Versus Corpectomy-ACDF “Hybrid” Procedures,” published in the May 2023 issue of Spinal Disorders and Techniques by Campion et al.
The researchers chose comparative longitudinal observational cohorts as the study design. This study compares sagittal radiographic parameters at 3 and 12 months and patient-reported outcomes (PROs) in patients who underwent a 3-level ACDF or a hybrid procedure. Common cervical spondylosis treatments include anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), and composites (combination ACCF-ACDF). Although much literature compares 1-level ACCF to 2-level ACDF and 2-level ACDF to 3-level ACDF, detailed comparisons between 3-level ACDF and hybrid procedures have yet to be thoroughly explored.
Patients who underwent a 3-Level ACDF (3L-ACDF, N=47) or a 1-Level Corpectomy/1-Level ACDF (Hybrid, N=52) with at least one year of post-op data were identified. In addition to preoperative and postoperative radiographic data, standard demographic, surgical, and PRO data were acquired, including C2 plumb line (C2PL), C2–C7 lordosis (CL), segmental lordosis (SL), and T1 slope (T1S). In terms of demographics, the two cohorts were similar. CL (9.04° vs. -2.12°, P=0.00) and SL (6.06° vs. -2.26°, P=0.003) were significantly greater in the 3L-ACDF group than in the HYBRID group 3 months after surgery. This significant difference was maintained 12 months postoperatively for CL but not SL (2.36° vs. -1.09°, P=0.199).
There were no differences in PROs between the two groups before surgery, 3 months, or 12 months after surgery. Seven patients required revision surgery during the one-year study period (1 in the 3L-ACDF and 6 in the Hybrid P<0.001). Three-level ACDF resulted in increased C2–C7 lordosis and segmental lordosis postoperatively, which were maintained at 1 year for cervical lordosis. While PROs were comparable between groups, patients treated with hybrid instrumentation required substantially more revision surgeries than those who received a 3-level ACDF.
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