LAUSR

OBJECTIVE To compare the cervical sagittal balance and surgical outcomes between anterior cervical discectomy and fusion (ACDF) and hybrid decompression and fusion (HDF: 1-level corpectomy combined with 1-level discectomy) for consecutive 3-level cervical spondylotic myelopathy (CSM). METHODS From January 2013 to June 2016, 82 patients with 3-level CSM who underwent ACDF (n = 40) and HDF (n = 42) were retrospectively reviewed. Perioperative parameters, clinical outcomes and radiological sagittal alignment were analyzed and compared. RESULTS Patients were followed up for 35.5 ± 6.5 months (range, 25-53 months). All patients had achieved significant improvement of Neck Disability Index and Japanese Orthopedic Association scores after operation, with similar clinical outcomes between both groups (P > 0.05). In ACDF group, 2 patients were found with axial symptoms, 1 with hoarseness. In HDF group, 5 patients were found with axial symptoms, 1 with hoarseness, 1 with dysphagia, and 1 with pseudarthrosis. ACDF group had less operation time and bleeding compared with HDF group (P < 0.05). The restoration of segmental and C2-7 lordosis were significantly greater in ACDF group than HDF group (P < 0.05). The C2-7 sagittal vertical axis and T1 slope minus C2-7 lordosis decreased in ACDF group at final follow-up (P < 0.05), however, there was no obvious change in those of HDF groups (P > 0.05). CONCLUSIONS Both ACDF and HDF were safe and effective for the treatment of 3-level CSM. ACDF showed superiority to HDF in terms of less blood loss, shorter operation time, and better postoperative sagittal balance.