Comparative Outcomes of Anterior Cervical Discectomy and Fusion Vs Hybrid Surgery in Multilevel Cervical Degenerative Disc Disease: A Systematic Review and Meta-analysis

<sec><title>Background</title> In recent years, hybrid surgery (HS), which combines cervical disc replacement and anterior cervical discectomy and fusion (ACDF) in treating multilevel cervical degenerative disc disease (CDDD), has emerged; however, its advantages over ACDF remain uncertain. This study aims to evaluate the safety, effectiveness, and reliability of HS and to provide updated insights into its clinical application and support surgical decision-making. </sec><sec><title>Methodology</title> This study included 20 articles that compared ACDF and HS in multilevel CDDD from January 2017 to January 2025. The following outcomes were analyzed: operation time, blood loss, hospital stay, functional parameters (visual analog scale, Neck Disability Index, and Japanese Orthopedic Association scores), radiological parameters (range of motion [ROM], T1 slope, cervical lordosis, sagittal vertical axis), complications, reoperation, and adjacent segment disease (ASD). To enhance the reliability of results, Egger’s and Begg’s tests, sensitivity, and meta-regression analyses were performed. </sec><sec><title>Results</title> The pooled analysis showed that ACDF demonstrated greater loss of cervical spine motion (<italic>P</italic> < 0.0001) and increased superior adjacent segment ROM (<italic>P</italic> < 0.0001), suggesting increased burden on the adjacent segments. Whereas HS was associated with a lower incidence of ASD (<italic>P</italic> = 0.05). In addition, complication incidence (<italic>P</italic> = 0.02) and dysphagia (<italic>P</italic> = 0.02) were significantly lower in the HS group, suggesting a favorable safety profile. Heterotopic ossification was not observed in any of the ACDF cases (<italic>P</italic> = 0.02). No significant differences were noted in other functional or radiological outcomes. </sec><sec><title>Conclusion</title> This meta-analysis provided updated evidence on the clinical outcomes of HS and ACDF in multilevel CDDD. HS offers advantages when it comes to preserving ROM, with trends toward lower complication and reoperation rates, as well as reduced incidence of ASD. On the other hand, ACDF is a favorable option in terms of lower operative time and blood loss. Both treatments have comparable postoperative functional outcomes. This suggests that HS is an effective and reliable surgical alternative. By combining fusion and motion-preserving components, HS allows surgeons to decide based on specific pathology at each spinal level, resulting in a more individualized and biomechanically balanced approach. </sec><sec><title>Clinical Relevance</title> Comparing outcomes of ACDF and HS can assist surgical decision-making in multilevel CDDD, supporting individualized treatment planning. </sec><sec><title>Level of Evidence</title> 1. </sec>