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Purpose  To compare sagittal alignment and clinical outcomes between three-level hybrid surgery (HS) and anterior cervical discectomy and fusion (ACDF) on cervical spondylotic myelopathy (CSM) over a 5-year follow-up.    Method  The study included 32 patients with ACDF, 36 patients with 1 prosthesis and 2 cages (HS1 group), and 25 cases with 2 prostheses and 1 cage (HS2 group). Alignment parameters included C2–C7 cervical lordosis (CL), C2–C7 sagittal vertical axis (SVA), T1 slope (T1S), and T1S minus CL (T1SCL). Radiographic parameters were range of motion (ROM), upper and lower adjacent ROM (UROM and LROM), and operated-segment lordosis (OPCL), as well as adjacent segment degeneration (ASD). Clinical outcomes included the neck disability index (NDI) and Japanese Orthopedic Association (JOA) score.    Results  Three groups were well-matched in demographics. All groups gained comparable improvement on NDI and JOA ( P  < 0.01). All groups gained CL improvement at the final visit ( P  < 0.05). There were no statistical differences on SVA and T1SCL among the groups and among preoperation, 1 week later, and final follow-up ( P  > 0.05) while T1S improved at 1 week later and final follow-up with HS2. The final change of all alignment parameters among the three groups was of no differences. ROM decreased and OPCL increased in all groups at the final follow-up ( P  < 0.05). UROM and LROM increased with ACDF but kept stable with HS1 and HS2. There was no inter-group difference on the incidence of ASD ( P  > 0.05).    Conclusion  Cervical alignment was comparably improved. HS and ACDF provided identified mid-term efficacy, and it was not necessary to have to use prosthesis on three-level CSM.

journal of orthopaedic surgery and research

Exploration on sagittal alignment and clinical outcomes after consecutive three-level hybrid surgery and anterior cervical discectomy and fusion: a minimum of a 5-year follow-up