{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T04:25:36Z","timestamp":1793679936486,"version":"4.5.1"},"reference-count":37,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2026,4,26]],"date-time":"2026-04-26T00:00:00Z","timestamp":1777161600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,4,26]],"date-time":"2026-04-26T00:00:00Z","timestamp":1777161600000},"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":[[2026,11]]},"abstract":"<jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>Systematic review and meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare the clinical, radiographic, fusion and complication outcomes between three-level anterior cervical discectomy and fusion (ACDF) and hybrid constructs combining ACDF and cervical disc arthroplasty (CDA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Systematic search of PubMed, Embase, Scopus, and Web of Science was performed in accordance with PRISMA guidelines. Comparative studies evaluating three-level ACDF and three-level hybrid surgery were included. Primary outcomes included neck disability index(NDI), visual analogue scale(VAS) scores, Japanese Orthopaedic Association (JOA) scores, C2-C7 Cobb angle, C2-7 range of motion (ROM), fusion rates, and complications. Random-effects meta-analyses were performed. Heterogeneity and publication bias were assessed using standard statistical methods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twelve studies comprising 1008 patients (553 hybrid and 455 ACDF) met the inclusion criteria. Both surgical strategies demonstrated significant improvements in NDI (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.62), VAS [neck (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.40), arm(\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.70)], and JOA (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.97) scores, with no significant between-group differences across clinical outcomes. Hybrid constructs maintained ROM (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.06), and cervical lordosis (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.93) comparable to ACDF. Fusion rates at intended arthrodesis levels were high and similar in both cohorts. There were no significant differences in total, early or late complication rates, although heterogeneity was moderate to high across several outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In three-level cervical degenerative disease, hybrid surgery and ACDF provide equivalent improvements in pain, disability, neurological recovery, alignment, fusion success, and complication profiles. Hybrid constructs demonstrated a trend towards greater preservation cervical range of motion without compromising clinical efficacy or safety. These findings support hybrid surgery as a selective, motion-preserving alternative to three-level ACDF in appropriately chosen patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence<\/jats:title>\n                    <jats:p>II.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682261447886","type":"journal-article","created":{"date-parts":[[2026,4,26]],"date-time":"2026-04-26T09:32:47Z","timestamp":1777195967000},"page":"4178-4195","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Is Motion Preservation With Three-Level Hybrid Cervical Surgery Achieved Without Compromising Clinical Outcomes? A Systematic Review and Meta-Analysis"],"prefix":"10.1177","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3804-1698","authenticated-orcid":false,"given":"Vibhu Krishnan","family":"Viswanathan","sequence":"first","affiliation":[{"name":"University of Alabama"},{"name":"Department of Spine Surgery, Orthopaedic Research Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7143-4354","authenticated-orcid":false,"given":"Sathish","family":"Muthu","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Orthopaedic Research Group"},{"name":"Vinayaka Mission\u2019s Research Foundation (Deemed to be University)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vaishnavi","family":"Sampathkumar","sequence":"additional","affiliation":[{"name":"Swamy Vivekananda Medical College and Research Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1071-0084","authenticated-orcid":false,"given":"Dhibin Vikash","family":"Kolarpatti Ponnusamy","sequence":"additional","affiliation":[{"name":"Government Medical College"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satish Kumar","family":"Rajappan Chandra","sequence":"additional","affiliation":[{"name":"SRM Institute of Science and Technology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1040-3746","authenticated-orcid":false,"given":"Khan","family":"Sharun","sequence":"additional","affiliation":[{"name":"Yuan Ze University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sakthivel Rajan","family":"Rajaram Manoharan","sequence":"additional","affiliation":[{"name":"University of 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