Neurosurg Focus. 2026 Jul 1;61(1):E9. doi: 10.3171/2026.3.FOCUS251207.
ABSTRACT
OBJECTIVE: Anterior cervical disc arthroplasty offers theoretical advantages over fusion such as quicker recovery and decreased biomechanical stress at adjacent levels. However, anterior cervical discectomy and fusion (ACDF) may be beneficial for patients with dynamic instability or advanced spondylosis. In patients with multilevel cervical degenerative disc disease, anterior cervical hybrid arthroplasty-fusion (ACHAF) constructs may allow for personalized approaches, addressing level-specific pathology while offering other theoretical advantages such as requiring a shorter anterior plate (if utilized), potentially reducing complications and risk of dysphagia. The authors aimed to evaluate radiographic outcomes and early safety of ACHAF compared with ACDF.
METHODS: This is a single-center retrospective study of patients who underwent 2- or 3-level ACHAF or ACDF between January 2021 and May 2025 by the senior author. In the ACHAF group, arthroplasty was performed at the most cephalad level. Radiographic parameters (C2-7 lordosis, C2-7 sagittal vertical axis [cSVA], and Cobb angle and height of the disc immediately proximal to the construct) were assessed preoperatively and at 6 months postoperatively. Clinical outcomes included length of stay and rates of return to the emergency department (ED) within 90 days, complications, dysphagia at 6 months postoperatively, and reoperation during the study period.
RESULTS: A total of 66 patients met the study criteria: 23 underwent ACHAF and 43 underwent ACDF (mean age 57.9 years). There was no difference in change of C2-7 lordosis or cSVA. The ACHAF group exhibited a decreased adjacent disc Cobb angle and increased disc height postoperatively, whereas the ACDF group exhibited an increased disc Cobb angle and decreased disc height (p < 0.001). Dysphagia at 6 months was more frequent in ACDF patients (32.6% vs 8.7%, p = 0.04). There was no significant difference in reoperation rates during the study period. Complications (p = 0.29) were more common in the ACDF group, and return to ED was more frequent in the ACHAF group (p = 0.71), although these did not meet statistical significance. There was no difference in rates of discharge on postoperative day 1 (p > 0.99).
CONCLUSIONS: ACHAF constructs possibly reduce stress on the proximal unoperated motion segment due to adjacent load sharing from the arthroplasty. Furthermore, dysphagia at 6 months postoperatively was less prevalent in the ACHAF group. Additional studies are needed to determine if ACHAF is associated with differences in patient-reported outcomes or long-term differences in rates of dysphagia or reoperation.
PMID:42385243 | DOI:10.3171/2026.3.FOCUS251207
