{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T10:00:30Z","timestamp":1790589630931,"version":"4.1.0"},"reference-count":35,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T00:00:00Z","timestamp":1770595200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T00:00:00Z","timestamp":1770595200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Systematic Review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To compare clinical, radiological, and complication outcomes between three-level hybrid surgery [combining cervical disc arthroplasty (CDA) with anterior cervical discectomy and fusion (ACDF)] and three-level ACDF alone in patients with multilevel cervical degenerative disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review and meta-analysis were conducted following PRISMA guidelines. Nine retrospective cohort studies (704 patients: 450 HS, 254 ACDF) were included. Pooled mean differences (MD) with 95% confidence intervals (CI) were calculated for clinical, radiological, perioperative, and complication outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Both HS and ACDF significantly improved disability and myelopathy scores, with no differences in NDI or mJOA. HS preserved better the operated-level ROM (MD + 5.79\u00b0; 95% CI 2.38 \u2013 9.21;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.0009), while adjacent segment motion did not differ. Arm pain improvement showed a non-significant trend favouring HS (MD \u20132.63;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.08), and neck pain was similar. Both procedures improved segmental lordosis; global alignment remained stable. Complications differed: instrumentation failure was more common with ACDF (33.3% vs 5.2%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.02), while HO occurred in 41.2% of hybrid constructs, reflecting loss of arthroplasty motion.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Three-level HS and ACDF provide comparable clinical outcomes. HS is a promising alternative, providing better motion preservation but at the cost of a higher risk of heterotopic ossification, while ACDF may be associated with a higher rate of instrumentation failure. Long-term prospective studies are still needed to strengthen these conclusions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682261424764","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T09:55:31Z","timestamp":1770630931000},"page":"3637-3649","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Three-Level Cervical Disc Arthroplasty Combined With Fusion Versus Three-Level ACDF: A Systematic Review and Meta-Analysis"],"prefix":"10.1177","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0996-1847","authenticated-orcid":false,"given":"Chinedu","family":"Egu","sequence":"first","affiliation":[{"name":"South Tyneside and Sunderland Royal Hospital NHS Foundation Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neel","family":"Badhe","sequence":"additional","affiliation":[{"name":"Cambridge University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hussein","family":"Akil","sequence":"additional","affiliation":[{"name":"University of Balamand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca Aida","family":"Hakim","sequence":"additional","affiliation":[{"name":"Bristol Royal Infirmary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7130-3349","authenticated-orcid":false,"given":"Elie","family":"Najjar","sequence":"additional","affiliation":[{"name":"Queen\u2019s Medical Centre"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Balaji","family":"Purushothaman","sequence":"additional","affiliation":[{"name":"South Tyneside and Sunderland Royal Hospital NHS Foundation Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,2,9]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-004-0864-4"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.berh.2011.01.019"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-195840030-00009"},{"issue":"3","key":"e_1_3_3_5_2","first-page":"165","article-title":"Cervical spondylotic myelopathy: a review of surgical indications and decision making","volume":"66","author":"Bernhardt M","year":"1993","unstructured":"Bernhardt M. 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