Anterior Cervical Discectomy and Fusion vs. Anterior Cervical Corpectomy and Fusion for 2-Level Degenerative Cervical Myelopathy: A Systematic Review and Meta-Analysis.

Abstract

Background: Cervical spondylotic myelopathy (CSM) is a common cause of progressive neurological decline in elderly patients, often necessitating surgical decompression. Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are commonly used procedures. However, there is no consensus on the superior approach, particularly in cases involving 2-level CSM.

Methods: A systematic review and meta-analysis were conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. PubMed, Cochrane, Scopus, and Embase databases were searched for studies comparing perioperative, clinical, and radiological outcomes of ACDF and ACCF in 2-level CSM. Fourteen studies with 4,449 patients (ACDF: 2,265, ACCF: 2,184) met the inclusion criteria. Outcomes analyzed included operating (OR) time, blood loss, hospital stay, patient-reported outcomes (Neck Disability Index [NDI], Visual Analog Scale [VAS], modified Japanese Orthopaedic Association [mJOA], Odom criteria), radiological parameters, complications, and fusion rates. Statistical analysis was performed using Review Manager 5.4, with heterogeneity assessed using I2 statistics.

Results: ACDF was associated with significantly shorter OR time, reduced blood loss, shorter hospital stays, and lower overall complication rates compared with ACCF. Both procedures showed comparable improvements in NDI, VAS, and mJOA scores. ACDF demonstrated superior postoperative cervical alignment, with greater improvements in global and segmental lordosis. Complication rates, including implant-related issues, were higher in the ACCF group, while reoperation and fusion rates were similar.

Conclusion: Both ACDF and ACCF significantly improve functional outcomes in 2-level CSM. However, ACDF demonstrated advantages in perioperative outcomes, complications, and cervical alignment. While ACDF is associated with shorter OR time and fewer complications, ACCF may be necessary in cases with extensive disk herniation or other pathologies requiring direct decompression posterior to the vertebral body. Surgical decisions should be individualized based on patient-specific pathology.

Level of evidence: Level II. See Instructions for Authors for a complete description of levels of evidence.