{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T07:25:15Z","timestamp":1791617115070,"version":"4.3.4"},"reference-count":44,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      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 I\n                      <jats:sup>2<\/jats:sup>\n                      statistics.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      <jats:underline>Level II<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.rvw.24.00204","type":"journal-article","created":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T08:44:32Z","timestamp":1743151472000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":16,"title":["Anterior Cervical Discectomy and Fusion vs. Anterior Cervical Corpectomy and Fusion for 2-Level Degenerative Cervical Myelopathy"],"prefix":"10.2106","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2400-1086","authenticated-orcid":false,"given":"Aman","family":"Verma","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8033-4790","authenticated-orcid":false,"given":"Anil","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2176-1693","authenticated-orcid":false,"given":"Utsav","family":"Anand","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4936-7896","authenticated-orcid":false,"given":"Siddharth Sekhar","family":"Sethy","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9445-6452","authenticated-orcid":false,"given":"Aakash","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5903-924X","authenticated-orcid":false,"given":"Vibhor","family":"Abrol","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1344-9889","authenticated-orcid":false,"given":"Kaustubh","family":"Ahuja","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1317-534X","authenticated-orcid":false,"given":"Bhaskar","family":"Sarkar","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8801-6909","authenticated-orcid":false,"given":"Pankaj","family":"Kandwal","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,3]]},"reference":[{"issue":"6","key":"r1-20250325","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1177\/2192568217699208","article-title":"Current diagnosis and management of cervical spondylotic myelopathy","volume":"7","author":"Bakhsheshian","year":"2017","journal-title":"Glob Spine J"},{"issue":"4","key":"r2-20250325","doi-asserted-by":"crossref","first-page":"669","DOI":"10.4103\/ajns.AJNS_313_20","article-title":"Anterior approach to the cervical spine: elegance lies in its simplicity","volume":"16","author":"Arumalla","year":"2021","journal-title":"Asian J Neurosurg"},{"issue":"5","key":"r3-20250325","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1007\/s00586-009-0897-9","article-title":"Comparison between anterior cervical discectomy fusion and cervical corpectomy fusion using titanium cages for reconstruction: analysis of outcome and long-term follow-up","volume":"18","author":"Uribe","year":"2009","journal-title":"Eur Spine J"},{"issue":"2","key":"r4-20250325","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1007\/BF01358747","article-title":"Anterior cervical allograft arthrodesis and instrumentation: multilevel interbody grafting or strut graft reconstruction","volume":"6","author":"Swank","year":"1997","journal-title":"Eur Spine J"},{"issue":"3","key":"r5-20250325","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1080\/02688690410001732643","article-title":"A retrospective study of multiple interbody grafting and long segment strut grafting following multilevel anterior cervical decompression","volume":"18","author":"Nirala","year":"2004","journal-title":"Br J Neurosurg"},{"key":"r6-20250325","doi-asserted-by":"crossref","DOI":"10.1097\/BRS.0000000000005279","article-title":"Staged versus simultaneous surgery for adult spinal deformity: a systematic review and meta-analysis","author":"Verma","year":"2025","journal-title":"Spine (Phial Pa 1976)"},{"issue":"1","key":"r7-20250325","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1177\/21925682221090926","article-title":"Is final fusion necessary for growing-rod graduates: a systematic review and meta-analysis","volume":"13","author":"Ahuja","year":"2023","journal-title":"Glob Spine J"},{"key":"r8-20250325","doi-asserted-by":"crossref","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"BMJ"},{"key":"r9-20250325","doi-asserted-by":"crossref","first-page":"1004870","DOI":"10.3389\/fsurg.2022.1004870","article-title":"Comparison of oblique and transforaminal approaches to lumbar interbody fusion for lumbar degenerative disease: an updated meta-analysis","volume":"9","author":"Lin","year":"2022","journal-title":"Front Surg"},{"issue":"1","key":"r10-20250325","doi-asserted-by":"crossref","first-page":"E4","DOI":"10.3171\/2013.3.FOCUS1396","article-title":"A comparative effectiveness study of patient-rated and radiographic outcome after 2 types of decompression with fusion for spondylotic myelopathy: anterior cervical discectomy versus corpectomy","volume":"35","author":"Burkhardt","year":"2013","journal-title":"Neurosurg Focus"},{"issue":"1","key":"r11-20250325","doi-asserted-by":"crossref","first-page":"98","DOI":"10.21037\/jss-23-99","article-title":"Surgical tactics of two-segmental cervical degenerative diseases: risk factors retrospective assessment and preoperative planning","volume":"10","author":"Byvaltsev","year":"2024","journal-title":"J Spine Surg"},{"issue":"1","key":"r12-20250325","doi-asserted-by":"crossref","first-page":"10225536231167704","DOI":"10.1177\/10225536231167704","article-title":"Comparison of anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion in the treatment of localized ossification of the posterior longitudinal ligament","volume":"31","author":"Chen","year":"2023","journal-title":"J Orthop Surg"},{"key":"r13-20250325","doi-asserted-by":"crossref","first-page":"21925682241309907","DOI":"10.1177\/21925682241309907","article-title":"Letter re: letter to editor concerning: \u2018meta-analysis of treatment for adjacent two-segment cervical spondylotic myelopathy: a comparison between anterior cervical corpectomy and fusion and anterior cervical discectomy and fusion\u2019 by Chen et al","volume":"25","author":"Verma","year":"2024","journal-title":"Glob Spine J"},{"issue":"4","key":"r14-20250325","doi-asserted-by":"crossref","first-page":"871","DOI":"10.14245\/ns.2040134.067","article-title":"Perioperative outcomes in 17,947 patients undergoing 2-level anterior cervical discectomy and fusion versus 1-level anterior cervical corpectomy for treatment of cervical degenerative conditions: a propensity score matched national surgical quality improvement program analysis","volume":"17","author":"Galivanche","year":"2020","journal-title":"Neurospine"},{"issue":"3","key":"r15-20250325","doi-asserted-by":"crossref","first-page":"197","DOI":"10.14245\/kjs.2012.9.3.197","article-title":"Comparisons of two-level discectomy and fusion with cage alone versus single-level corpectomy and fusion with plate in the treatment of cervical degenerative disc disease","volume":"9","author":"Ha","year":"2012","journal-title":"Korean J Spine."},{"issue":"5","key":"r16-20250325","doi-asserted-by":"crossref","first-page":"188","DOI":"10.47102\/annals-acadmedsg.V44N5p188","article-title":"Single-level anterior corpectomy with fusion versus 2-level anterior cervical decompression with fusion: a prospective controlled study with 2-year follow-up using cages for fusion","volume":"44","author":"Hey","year":"2015","journal-title":"Ann Acad Med Singapore"},{"issue":"3","key":"r17-20250325","doi-asserted-by":"crossref","first-page":"135","DOI":"10.3340\/jkns.2012.51.3.135","article-title":"Radiographic comparison of four anterior fusion methods in two level cervical disc diseases: autograft plate fixation versus cage plate fixation versus stand-alone cage fusion versus corpectomy and plate fixation","volume":"51","author":"Kim","year":"2012","journal-title":"J Korean Neurosurg Soc"},{"issue":"2","key":"r18-20250325","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1007\/s00402-014-2123-4","article-title":"Anterior cervical discectomy and fusion versus corpectomy and fusion in treating two-level adjacent cervical spondylotic myelopathy: a minimum 5-year follow-up study","volume":"135","author":"Liu","year":"2015","journal-title":"Arch Orthop Trauma Surg"},{"issue":"7","key":"r19-20250325","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1097\/BRS.0b013e318199690a","article-title":"Two-level anterior cervical discectomy versus one-level corpectomy in cervical spondylotic myelopathy","volume":"34","author":"Oh","year":"2009","journal-title":"Spine (Phila Pa 1976)"},{"issue":"3","key":"r20-20250325","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.spinee.2009.09.006","article-title":"Comparison of anterior cervical fusion after two-level discectomy or single-level corpectomy: sagittal alignment, cervical lordosis, graft collapse, and adjacent-level ossification","volume":"10","author":"Park","year":"2010","journal-title":"Spine J"},{"key":"r21-20250325","doi-asserted-by":"crossref","first-page":"105919","DOI":"10.1016\/j.clineuro.2020.105919","article-title":"Adjacent two-level anterior cervical discectomy and fusion versus one-level corpectomy and fusion in cervical spondylotic myelopathy: analysis of perioperative parameters and sagittal balance","volume":"194","author":"Qiu","year":"2020","journal-title":"Clin Neurol Neurosurg"},{"issue":"3","key":"r22-20250325","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1097\/00002517-200106000-00006","article-title":"A comparison of fusion rates between single-level cervical corpectomy and two-level discectomy and fusion","volume":"14","author":"Wang","year":"2001","journal-title":"J Spinal Disord"},{"issue":"8","key":"r23-20250325","doi-asserted-by":"crossref","first-page":"1877","DOI":"10.1007\/s00264-018-3804-3","article-title":"Anterior cervical corpectomy and fusion versus discectomy and fusion for the treatment of two-level cervical spondylotic myelopathy: analysis of sagittal balance and axial symptoms","volume":"42","author":"Zhang","year":"2018","journal-title":"Int Orthop"},{"key":"r24-20250325","doi-asserted-by":"crossref","first-page":"e923748","DOI":"10.12659\/MSM.923748","article-title":"Analysis of cervical sagittal balance in treating cervical spondylotic myelopathy: 1-level anterior cervical corpectomy and fusion versus 2-level anterior cervical discectomy and fusion","volume":"26","author":"Zhou","year":"2020","journal-title":"Med Sci Monit"},{"key":"r25-20250325","first-page":"100567","article-title":"Comparison of anterior and posterior approaches for functional improvement in cervical myelopathy: a systematic review and meta-analysis of 33,025 patients","volume":"2024","author":"Aleid","year":"2024","journal-title":"North Am Spine Soc J"},{"issue":"8","key":"r26-20250325","doi-asserted-by":"crossref","first-page":"1621","DOI":"10.1007\/s00586-015-3911-4","article-title":"Comparison of anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy","volume":"24","author":"Luo","year":"2015","journal-title":"Eur Spine J"},{"issue":"6","key":"r27-20250325","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1080\/02688697.2017.1348487","article-title":"Anterior discectomy could still be an alternative to corpectomy in highly migrated cervical disc herniation","volume":"31","author":"Wang","year":"2017","journal-title":"Br J Neurosurg"},{"issue":"2","key":"r28-20250325","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1007\/s00402-011-1402-6","article-title":"Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion for multilevel cervical spondylosis: a systematic review","volume":"132","author":"Jiang","year":"2012","journal-title":"Arch Orthop Trauma Surg"},{"issue":"7","key":"r29-20250325","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.2106\/JBJS.F.00014","article-title":"Operative treatment of cervical spondylotic myelopathy","volume":"88","author":"Rao","year":"2006","journal-title":"J Bone Joint Surg Am"},{"issue":"8","key":"r30-20250325","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.1007\/s00586-012-2296-x","article-title":"Efficacy of multilevel anterior cervical discectomy and fusion versus corpectomy and fusion for multilevel cervical spondylotic myelopathy: a minimum 5-year follow-up study","volume":"21","author":"Song","year":"2012","journal-title":"Eur Spine J"},{"key":"r31-20250325","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/s12891-015-0490-9","article-title":"Anterior cervical discectomy and fusion may be more effective than anterior cervical corpectomy and fusion for the treatment of cervical spondylotic myelopathy","volume":"16","author":"Guan","year":"2015","journal-title":"BMC Musculoskelet Disord"},{"key":"r32-20250325","doi-asserted-by":"crossref","first-page":"5337483","DOI":"10.1155\/2022\/5337483","article-title":"VAS and NRS, same or different? Are visual analog scale values and numerical rating scale equally viable tools for assessing patients after microdiscectomy?","volume":"2022","author":"Bielewicz","year":"2022","journal-title":"Pain Res Manag"},{"issue":"3","key":"r33-20250325","doi-asserted-by":"crossref","first-page":"435","DOI":"10.14245\/ns.1938196.098","article-title":"Outcome measures and variables affecting prognosis of cervical spondylotic myelopathy: WFNS spine committee recommendations","volume":"16","author":"Zileli","year":"2019","journal-title":"Neurospine"},{"issue":"7","key":"r34-20250325","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1016\/j.spinee.2019.03.002","article-title":"Reliability of the Neck Disability Index and Japanese Orthopedic Association questionnaires in adult cervical radiculopathy and myelopathy patients when administered by telephone or via online format","volume":"19","author":"Gupte","year":"2019","journal-title":"Spine J"},{"issue":"14","key":"r35-20250325","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.2106\/JBJS.18.00370","article-title":"The Odom criteria: validated at last: a clinimetric evaluation in cervical spine surgery","volume":"101","author":"Broekema","year":"2019","journal-title":"J Bone Joint Surg Am"},{"issue":"22 suppl 1","key":"r36-20250325","doi-asserted-by":"crossref","first-page":"S161","DOI":"10.1097\/BRS.0b013e3182a7eb9e","article-title":"Association of myelopathy scores with cervical sagittal balance and normalized spinal cord volume: analysis of 56 preoperative cases from the AOSpine North America Myelopathy study","volume":"38","author":"Smith","year":"2013","journal-title":"Spine (Phila Pa 1976)"},{"issue":"21","key":"r37-20250325","doi-asserted-by":"crossref","first-page":"E1265","DOI":"10.1097\/BRS.0000000000001615","article-title":"Effect of preoperative sagittal balance on cervical laminoplasty outcomes","volume":"41","author":"Oshima","year":"2016","journal-title":"Spine (Phila Pa 1976)"},{"issue":"3","key":"r38-20250325","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1227\/NEU.0b013e31826100c9","article-title":"The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery","volume":"71","author":"Tang","year":"2012","journal-title":"Neurosurgery"},{"issue":"4","key":"r39-20250325","doi-asserted-by":"crossref","first-page":"E220","DOI":"10.1097\/BRS.0000000000000722","article-title":"T1 slope and degenerative cervical spondylolisthesis","volume":"40","author":"Jun","year":"2015","journal-title":"Spine (Phila Pa 1976)"},{"issue":"suppl 1","key":"r40-20250325","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1007\/s00586-017-5367-1","article-title":"Cervical sagittal balance: a biomechanical perspective can help clinical practice","volume":"27","author":"Patwardhan","year":"2018","journal-title":"Eur Spine J"},{"issue":"1","key":"r41-20250325","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12891-018-2378-y","article-title":"Analysis of sagittal alignment parameters following anterior cervical hybrid decompression and fusion of multilevel cervical spondylotic myelopathy","volume":"20","author":"Huang","year":"2019","journal-title":"BMC Musculoskelet Disord"},{"issue":"6","key":"r42-20250325","doi-asserted-by":"crossref","first-page":"537","DOI":"10.3171\/2013.2.SPINE12525","article-title":"Relationship between degree of focal kyphosis correction and neurological outcomes for patients undergoing cervical deformity correction surgery","volume":"18","author":"Grosso","year":"2013","journal-title":"J Neurosurg Spine"},{"issue":"9","key":"r43-20250325","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1007\/s00586-011-1735-4","article-title":"Outcomes of three anterior decompression and fusion techniques in the treatment of three-level cervical spondylosis","volume":"20","author":"Guo","year":"2011","journal-title":"Eur Spine J"},{"issue":"3","key":"r44-20250325","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1007\/s00586-011-1961-9","article-title":"A comparison of anterior cervical discectomy and corpectomy in patients with multilevel cervical spondylotic myelopathy","volume":"21","author":"Lin","year":"2012","journal-title":"Eur Spine J"}],"container-title":["JBJS Reviews"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.RVW.24.00204","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:27:24Z","timestamp":1787750844000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.RVW.24.00204"}},"subtitle":["A Systematic Review and Meta-Analysis"],"short-title":[],"issued":{"date-parts":[[2025,3]]},"references-count":44,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.rvw.24.00204","relation":{},"ISSN":["2329-9185"],"issn-type":[{"value":"2329-9185","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3]]}}}