Two-Level Anterior Cervical Discectomy and Fusion versus One-Level Anterior Cervical Corpectomy and Fusion in Cervical Spondylotic Myelopathy: A Systematic Review and Meta-Analysis
Research Fellow University of North Carolina at Chapel Hill Chapel Hill, NC, US
Introduction: Cervical spondylotic myelopathy (CSM) poses a substantial burden on patients, necessitating surgical intervention to alleviate spinal cord compression and associated symptoms. The choice between two-level anterior cervical discectomy and fusion (ACDF) and one-level anterior cervical corpectomy and fusion (ACCF) remains a pivotal decision in the surgical management of CSM. While both procedures aim to address spinal cord compression, these approaches' clinical and radiological outcomes require thorough investigation to guide clinical decision-making. This meta-analysis aims to systematically evaluate and compare the outcomes of two-level ACDF versus one-level ACCF in patients with CSM.
Methods: A systematic search was conducted using the electronic databases PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE from inception through September 2024 following the PRISMA statement. Studies were included if they met the following criteria: 1) compare two-level ACDF and one-level ACCF in patients with CSM, 2) available data on at least one outcome of interest, 3) RCTs and non-RCTs, and 4) English language. Statistical analysis was conducted using R version 4.3.2 with the packages ‘meta’ and ‘metafor’. The random effects model for pooled relative risk was estimated using the Mantel–Haenszel method for categorical variables and DerSimonian–Laird method for continuous variables.
Results: Across the six studies involving 3,280 patients, were observed a significant improvement in Cobb's angle (MD 3.78, 95% CI 2.30 to 5.25, p< 0.01) and operative time (MD −34.94, 95% CI −47.54 to −22.33, p< 0.01) favoring two-level ACDF. There were no significant differences between fusion rates (RR 0.96, 95% CI 0.88 to 1.05, p=0.36) and no significant variations in neck disability index scores (SMD 0.16, 95% CI −0.07 to 0.39, p=0.17).
Conclusion : Our meta-analysis underscores the superiority of two-level ACDF with a significant enhancement in Cobb's angle and reduced operative time, emphasizing the clinical efficacy of this approach. Importantly, comparable fusion rates and NDI scores between the two procedures suggest that while maintaining outcomes, two-level ACDF offers notable advantages in deformity correction and operative efficiency. These findings contribute valuable insights to guide evidence-based decision-making in the surgical management of cervical spondylotic myelopathy.