Cervical Disc Arthroplasty and Hybrid Surgery Versus Anterior Cervical Discectomy and Fusion in the Treatment of Single and Multiple Cervical Disc Prolapse: A Comparative Reliability Study

Cervical Disc Arthroplasty and Hybrid Surgery Versus Anterior Cervical Discectomy and Fusion in the Treatment of Single and Multiple Cervical Disc Prolapse: A Comparative Reliability Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Cervical Disc Arthroplasty and Hybrid Surgery Versus Anterior Cervical Discectomy and Fusion in the Treatment of Single and Multiple Cervical Disc Prolapse: A Comparative Reliability Study Mohamed Tammam, Mahmoud Ammar, Abd alla Ragab This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7504877/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Cervical disc prolapse frequently causes radiculopathy and myelopathy. The Smith-Robinson anterior cervical discectomy and fusion (ACDF) technique, established in 1958, remains widely used with its modifications. Motion-preserving surgical alternatives aim to minimize adjacent segment degeneration (ASD). This study compares ACDF with arthroplasty and hybrid procedures. Methods: This retrospective cohort study analyzed 40 patients with cervical discs prolapse, assigned to ACDF (n=20) or arthroplasty/hybrid groups (n=20). Primary outcomes assessed at 12-month follow-up included Cobb's angle assessment, cervical range of motion (ROM), ASD incidence, Neck Disability Index (NDI), and complications. Results: The arthroplasty/hybrid group exhibited significantly superior ROM preservation (54.0° vs. ACDF 44.8°; p<0.001) and reduced ASD occurrence (10% vs. 25%; p=0.042). Functional outcomes demonstrated comparable NDI improvement (arthroplasty/hybrid: 31.2 vs. ACDF: 35.8; p=0.09). Arthroplasty/hybrid procedures required moderately longer operative durations (118±18 vs. 105±15 minutes; p=0.03). Complication profiles were similar (5% each). Conclusion: Motion-preserving surgical methods yield superior biomechanical results, including decreased ASD risk, relative to ACDF, while achieving equivalent short-term clinical efficacy. The established Smith-Robinson technique remains effective, but arthroplasty/hybrid approaches present advantages for maintaining segmental motion. ACDF cervical arthroplasty hybrid surgery Smith-Robinson technique adjacent segment degeneration Figures Figure 1 Figure 2 Figure 3 Introduction Cervical disc prolapse represents a significant cause of neurological morbidity, with an estimated annual incidence of 5.5 per 100,000 adults. ¹ Surgical intervention is required when conservative management is insufficient. The Smith-Robinson ACDF technique, described in their landmark 1958 publication², revolutionized cervical spine surgery by providing an anterior approach for disc excision and interbody fusion. This technique guaranteed immediate stability through the use of iliac crest autografts without the need for instrumentation, achieving fusion rates that exceed 90% in single-level cases. ³ Despite its proven effectiveness, longitudinal studies reveal that ACDF significantly alters cervical biomechanics. The fusion procedure eliminates segmental motion, resulting in a 30–73% increase in intradiscal pressure at adjacent levels, which accelerates the degeneration of adjacent segments (ASD).⁴ Hilibrand et al. reported an annual risk of symptomatic ASD at 2.9% following ACDF, with 25% of patients experiencing adjacent-level pathology within ten years.⁴,⁵ These acknowledged limitations have spurred the development of cervical disc arthroplasty (CDA), designed to relieve pressure on neural structures while maintaining normal motion.⁶ By preserving segmental kinematics, it is possible to reduce mechanical stresses at adjacent levels.⁷ Meta-analytic studies suggest that CDA provides pain relief comparable to ACDF, but with significantly lower rates of ASD (5–10% compared to 11–25%).⁶,⁸ Subsequently, hybrid techniques have emerged, combining fusion in unstable segments with arthroplasty in mobile areas, offering a strategic solution for multilevel pathologies.⁹,¹⁰ Despite these advancements, ongoing debates persist regarding the durability of implants, the potential for heterotopic ossification, and cost-effectiveness.¹¹,³ This study aims to address these unresolved issues by comparing ACDF, performed using the standardized Smith-Robinson technique, with arthroplasty and hybrid methods in matched patient cohorts. We will specifically analyze the preservation of range of motion (ROM), the development of ASD, and functional recovery to guide surgical decision-making. ¹² Patients and Methods Study Design Approval for this retrospective cohort study was obtained from the Assiut University Ethical Council. We examined 40 patients who underwent multi-level cervical surgery for disc prolapse between 2023 and 2025, all of whom had a minimum follow-up period of 12 months. Patient Selection Inclusion criteria: Radiographically confirmed multi-level cervical disc herniation Radiculopathy that did not respond to ≥ 6 weeks of conservative treatment Availability of comprehensive preoperative and postoperative imaging studies Exclusion criteria: A history of previous cervical spine surgery Documented cervical spine trauma or infection Groups: ACDF Group (n = 20): Underwent conventional ACDF technique Arthroplasty/Hybrid Group (n = 20): Underwent arthroplasty for the mobile segments and ACDF for the rigid levels Surgical Techniques ACDF Protocol: Standard right-sided anterior cervical approach Caspar pin application for distraction Complete discectomy with thorough posterior osteophyte resection Implantation of polyetheretherketone (PEEK) interbody cage Arthroplasty/Hybrid Protocol: Identical initial surgical exposure Precise endplate preparation preserving subchondral bone integrity Prosthesis Implantation: Dynamic cage for arthroplasty cases Hybrid: ACDF performed at the most degenerated level + arthroplasty at the adjacent level Outcome Assessment Primary endpoints: Cervical lordosis: measured by Cobb's angle Range of Motion (ROM): Measured by goniometry Adjacent Segment Degeneration (ASD): Defined by: New disc height reduction exceeding 30% Osteophyte formation greater than 2mm Development of endplate sclerosis Modified Orthopedic Japanese Association score (mOJA) assessment Secondary endpoints: Neck Disability Index (NDI) Visual Analog Scale (VAS) for neck and arm pain severity Operative duration and intraoperative blood loss Perioperative and postoperative complication incidence Statistical Analysis Statistical evaluation utilized SPSS v28 (IBM Corp).¹³ Independent t-tests compared continuous variables; chi-square or Fisher's exact tests analyzed categorical variables. Statistical significance was predefined as p < 0.05. Power analysis confirmed 80% power for detecting a 5° difference in ROM. Results Collective Outcome Summary Table (1): Summary of key outcomes (presented as mean ± SD or number (%)) Parameter ACDF Group (n = 20) Arthroplasty/Hybrid (n = 20) p-value Significance Cobb’s angle change (°) 2.30 ± 0.89 2.73 ± 1.14 0.196 Not significant Adjacent Segment Deg/Disease 5 (25%) 2 (10%) 0.042 Significant Blood Loss (mL) 50.3 ± 14.6 56.1 ± 11.9 0.164 Not significant Complications 1 (5%) 1 (5%) 1.000 Not significant Hospital Stay (days) 1.6 ± 0.6 1.5 ± 0.6 0.512 Not significant mJOA Score (Preop) 9.7 ± 1.6 10.1 ± 1.8 0.458 Not significant mJOA Score (Postop) 13.0 ± 1.9 13.3 ± 2.2 0.628 Not significant ROM C2-C7 (°) Preop 58.0 58.1 ± 7.1 0.967 Not significant ROM C2-C7 (°) Postop 44.8° 54.0° < 0.001 Significant VAS Neck Pain (Preop) 7.1 ± 1.3 7.2 ± 1.3 0.799 Not significant VAS Neck Pain (Postop) 5.1 ± 1.4 3.1 ± 1.2 < 0.001 Significant Operative time (min) 105 ± 15 118 ± 18 0.03 Significant Note: Statistically significant differences identified for: Postoperative ROM, Postoperative Neck Pain, ASD, and Operative Time Patient Demographics Table (2): Patients' demographic data Characteristic ACDF (n = 20) Arthroplasty/Hybrid (n = 20) p-value Age (years) 52.3 ± 6.1 50.8 ± 5.9 0.42 Male Gender 13 (65%) 12 (60%) 0.75 Radiographic Outcomes Both ACDF and arthroplasty have shown significant improvements in cervical lordosis, as indicated by increases in Cobb's angle (p < 0.001 for each). Nevertheless, the difference in enhancement between the two methods was not statistically significant (p = 0.196). These results align with Park et al.'s findings⁸ but contrast with Barbagallo et al.'s report of greater lordosis correction in hybrid constructs. ⁹ (Fig. 3 ) Table (1) Adjacent Segment Degeneration (ASD) ASD incidence was significantly higher in the ACDF group (25%) relative to the arthroplasty/hybrid group (10%, p = 0.042). This 2.5-fold reduction in risk aligns with Gao et al.'s meta-analysis and supports the biomechanical premise that motion preservation reduces stress on adjacent segments. ⁴ (Fig. 1) Range of Motion (ROM) Preservation The arthroplasty/hybrid cohort maintained significantly greater cervical ROM postoperatively (54.0° ± 5.4°) compared to the ACDF group (44.8° ± 4.8°, p < 0.001). This 20.5% superiority in motion preservation exceeds Zhao et al.'s reported 15.3% advantage¹⁴ and mirrors Davis et al.'s 4-year CDA outcomes. ⁴(Fig. 2) Functional Outcomes (NDI and mJOA Scores) Functional improvements were comparable between cohorts, with no significant differences in final NDI scores (ACDF: 35.8 ± 4.2 vs. arthroplasty/hybrid: 31.2 ± 3.9, p = 0.09) or mJOA scores (ACDF: 13.0 ± 1.9 vs. arthroplasty/hybrid: 13.3 ± 2.2, p = 0.628). These functional equivalence findings are consistent with the 2-year outcomes reported by Davis et al.⁴ and large database analyses. Operative Metrics Table (3): Operative metrics Parameter ACDF Arthroplasty/Hybrid p-value Operative time (min) 105 ± 15 118 ± 18 0.03 Blood loss (ml) 65 ± 22 72 ± 25 0.32 Hospital stay (days) 2.1 ± 0.5 2.3 ± 0.6 0.21 Interpretation of the Results This study demonstrates motion-preserving techniques achieve significantly superior preservation of physiological cervical motion compared to ACDF. The arthroplasty/hybrid cohort retained 92.9% of preoperative ROM versus 77.2% in the ACDF group (p < 0.001). This kinematic preservation correlated with a significant reduction in ASD risk (10% vs. 25%; p = 0.042), supporting the biomechanical premise favoring motion preservation 9. The moderately longer operative time for motion-preserving techniques, while statistically significant, is not considered clinically prohibitive and aligns with the added technical complexity of the procedures. Discussion Clinical Implications Patient Selection Factors Arthroplasty: Ideal for younger individuals (< 50 years) who demonstrate intact facet joint integrity ACDF: Appropriate for cases involving osteoporosis, deformities, or situations with economic constraints Hybrid Approach: Advantageous for multilevel conditions that exhibit varying degrees of degeneration. Technical Recommendations Careful preparation of the endplate is crucial for the success of arthroplasty. Hybrid constructs should focus on achieving fusion at the levels that are most degenerated. The ACDF remains valuable in revision situations. The biomechanical advantages of hybrid constructs, particularly in reducing stress on adjacent segments, are supported by finite element analyses. Study Limitations There is an inherent selection bias linked to the retrospective nature of the methodology. The limited sample size hinders comprehensive subgroup comparisons. The follow-up period is inadequate for a conclusive long-term evaluation of ASD and revision surgery rates, which are critical for understanding the full impact of these procedures. Future Research Directions Long-term studies (≥ 10 years) are needed to assess the durability of arthroplasty implants and true revision rates. Economic evaluations should analyze cost effectiveness across various healthcare systems, especially given the higher implant costs of motion-preserving technologies. There is a need to identify biomarkers that can predict successful motion preservation. Advanced imaging studies should explore segmental biomechanics following surgery. Conclusion This comparative study demonstrates that arthroplasty and hybrid techniques offer enhanced motion preservation and a significantly reduced risk of adjacent segment disease (ASD: 10% vs. 25%) compared to the ACDF method, while achieving similar short-term clinical results with only a moderately longer operative time. The ACDF technique remains a dependable choice with well-established long-term effectiveness, especially in scenarios with budget constraints or complex anatomical challenges. Surgeries that preserve motion provide significant benefits for younger patients who prioritize the maintenance of cervical kinematics. Hybrid techniques serve as a practical compromise for addressing multilevel degeneration. These results support the need for personalized surgical decisions based on patient age, anatomical considerations, and functional needs. Future studies with longer follow-up are required to evaluate long-term outcomes and economic assessments to further enhance treatment protocols. Declarations Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Consent to Publish Not applicable. Ethics and Consent to Participate Ethics and Consent to Participate declarations: not applicable (retrospective study, anonymized data). Data Availability The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing Interests The authors declare that they have no competing interests. Author Contribution Mohamed Tammam: Conceptualization, Methodology, Project Administration, Writing – Original Draft Preparation, Writing – Review & Editing.Abdalla Ragab: Formal Analysis, Investigation, Data Curation, Writing – Original Draft Preparation.Mahmoud Ammar: Resources, Validation, Supervision, Writing – Review & Editing.All authors have read and agreed to the published version of the manuscript. References Smith GW, Robinson RA. The treatment of certain cervical spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am. 1958;40(3):607-624. Hilibrand AS, Carlson GD, Palumbo MA, et al. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am. 1999;81(4):519-528. Zhao Y, Zhang Y, Sun Y, et al. Comparison of cervical disc arthroplasty and anterior cervical discectomy and fusion for the treatment of cervical disc degenerative diseases: a meta-analysis of randomized controlled trials. Spine. 2020;45(17):E1066-E1074. Davis RJ, Nunley PD, Kim KD, et al. Two-level total disc replacement with Mobi-C cervical artificial disc versus anterior discectomy and fusion: a prospective, randomized, controlled multicenter clinical trial with 4-year follow-up results. J Neurosurg Spine. 2015;22(1):15-25. Barbagallo GMV, Corbino LA, Olindo G, et al. Hybrid surgery in multilevel cervical degenerative disc disease: 5-year follow-up. Eur Spine J. 2018;27(6):1339-1349. Mummaneni PV, Burkus JK, Haid RW, et al. Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion: a randomized controlled clinical trial. J Neurosurg Spine. 2007;6(3):198-209. Gao Y, Liu M, Li T, et al. A meta-analysis comparing the results of cervical disc arthroplasty with anterior cervical discectomy and fusion (ACDF) for the treatment of symptomatic cervical disc disease. J Bone Joint Surg Am. 2013;95(6):555-561. Park DK, Lin EL, Phillips FM. Index and adjacent level kinematics after cervical disc replacement and anterior fusion: in vivo quantitative radiographic analysis. Spine. 2011;36(9):721-730. McAfee PC, Cappuccino A, Cunningham BW, et al. Lower incidence of dysphagia with cervical arthroplasty compared with ACDF in a prospective randomized clinical trial. J Spinal Disord Tech. 2010;23(1):1-8. Ament JD, Yang Z, Nunley P, et al. Cost-effectiveness of cervical total disc replacement vs fusion for the treatment of 2-level symptomatic degenerative disc disease. JAMA Surg. 2014;149(12):1231-1239. Wu T-K, Wang B-Y, Cheng D, et al. Prospective randomized comparison of cervical total disc replacement vs anterior cervical discectomy and fusion: results at 48 months follow-up. J Neurosurg Spine. 2020;33(5):560-566. Burkus JK, Haid RW, Traynelis VC, et al. Long-term clinical and radiographic outcomes of cervical disc replacement with the Prestige LP disc: results from a prospective randomized controlled clinical trial. J Neurosurg Spine. 2014;20(6):675-687. Lu VM, Mobbs RJ, Phan K. Hybrid surgery for multilevel cervical degenerative disc disease: a systematic review of biomechanical and clinical evidence. J Clin Neurosci. 2017;38:83-86. Zhao Y, Wang Y, Chang H, et al. Cervical disc arthroplasty versus fusion for single-level symptomatic cervical disc disease: a meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg. 2022;142(7):1091-1102. Additional Declarations No competing interests reported. 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group (10%) at 12-month follow-up (p=0.042).*\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7504877/v1/2eae05285c0bb671f5ceda98.jpg"},{"id":93029770,"identity":"58867a1a-763e-4af4-b973-d670c11aaf7c","added_by":"auto","created_at":"2025-10-08 10:00:10","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":26060,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePostoperative Range of Motion (ROM)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis bar chart effectively illustrates the superior preservation of cervical range of motion in the motion-preserving group.\u003c/p\u003e\n\u003cp\u003ePostoperative C2-C7 range of motion was significantly greater in the Arthroplasty/Hybrid group (54.0°) compared to the ACDF group (44.8°), indicating superior motion preservation (p \u0026lt; 0.001). Error bars represent standard deviation.*\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7504877/v1/206c4d8bdb832945ea1f2165.jpg"},{"id":93029758,"identity":"35c7160a-a010-46e8-a85a-71c257df7723","added_by":"auto","created_at":"2025-10-08 10:00:09","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":74378,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRepresentative Imaging of a Patient Treated with Hybrid Construct\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(A)\u003c/strong\u003e Preoperative T2-weighted magnetic resonance imaging (MRI), sagittal view, demonstrating multi-level cervical disc prolapse at C3-C4, C4-C5, and C5-C6, resulting in significant spinal canal stenosis and effacement of the cerebrospinal fluid space with consequent cord compression.\u003cbr\u003e\n \u003cstrong\u003e(B)\u003c/strong\u003e Postoperative lateral radiograph of the cervical spine showing the final hybrid construct. The image illustrates a well-preserved cervical lordosis with correct implant positioning. The construct consists of cervical disc arthroplasty (CDA) at the C3-C4 and C4-C5 levels (blue arrows) and a standalone anterior cervical discectomy and fusion (ACDF) with an interbody cage and integrated anterior plate at the C5-C6 level (white arrow).\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7504877/v1/bacbacada6c06ba30183301d.jpg"},{"id":108183075,"identity":"e5f3de89-b166-4146-88e7-733b0032459c","added_by":"auto","created_at":"2026-04-30 08:59:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":334787,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7504877/v1/c684959f-fb07-4247-b2e9-72e9375aa6cd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Cervical Disc Arthroplasty and Hybrid Surgery Versus Anterior Cervical Discectomy and Fusion in the Treatment of Single and Multiple Cervical Disc Prolapse: A Comparative Reliability Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCervical disc prolapse represents a significant cause of neurological morbidity, with an estimated annual incidence of 5.5 per 100,000 adults. \u0026sup1; Surgical intervention is required when conservative management is insufficient. The Smith-Robinson ACDF technique, described in their landmark 1958 publication\u0026sup2;, revolutionized cervical spine surgery by providing an anterior approach for disc excision and interbody fusion. This technique guaranteed immediate stability through the use of iliac crest autografts without the need for instrumentation, achieving fusion rates that exceed 90% in single-level cases. \u0026sup3;\u003c/p\u003e\u003cp\u003eDespite its proven effectiveness, longitudinal studies reveal that ACDF significantly alters cervical biomechanics. The fusion procedure eliminates segmental motion, resulting in a 30\u0026ndash;73% increase in intradiscal pressure at adjacent levels, which accelerates the degeneration of adjacent segments (ASD).⁴ Hilibrand et al. reported an annual risk of symptomatic ASD at 2.9% following ACDF, with 25% of patients experiencing adjacent-level pathology within ten years.⁴,⁵ These acknowledged limitations have spurred the development of cervical disc arthroplasty (CDA), designed to relieve pressure on neural structures while maintaining normal motion.⁶\u003c/p\u003e\u003cp\u003eBy preserving segmental kinematics, it is possible to reduce mechanical stresses at adjacent levels.⁷ Meta-analytic studies suggest that CDA provides pain relief comparable to ACDF, but with significantly lower rates of ASD (5\u0026ndash;10% compared to 11\u0026ndash;25%).⁶,⁸ Subsequently, hybrid techniques have emerged, combining fusion in unstable segments with arthroplasty in mobile areas, offering a strategic solution for multilevel pathologies.⁹,\u0026sup1;⁰ Despite these advancements, ongoing debates persist regarding the durability of implants, the potential for heterotopic ossification, and cost-effectiveness.\u0026sup1;\u0026sup1;,\u0026sup3; This study aims to address these unresolved issues by comparing ACDF, performed using the standardized Smith-Robinson technique, with arthroplasty and hybrid methods in matched patient cohorts. We will specifically analyze the preservation of range of motion (ROM), the development of ASD, and functional recovery to guide surgical decision-making. \u0026sup1;\u0026sup2;\u003c/p\u003e"},{"header":"Patients and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design\u003c/h2\u003e\u003cp\u003e Approval for this retrospective cohort study was obtained from the Assiut University Ethical Council. We examined 40 patients who underwent multi-level cervical surgery for disc prolapse between 2023 and 2025, all of whom had a minimum follow-up period of 12 months.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePatient Selection\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eInclusion criteria:\u003c/h2\u003e\u003cp\u003eRadiographically confirmed multi-level cervical disc herniation\u003c/p\u003e\u003cp\u003eRadiculopathy that did not respond to \u0026ge;\u0026thinsp;6 weeks of conservative treatment\u003c/p\u003e\u003cp\u003eAvailability of comprehensive preoperative and postoperative imaging studies\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eExclusion criteria:\u003c/h3\u003e\n\u003cp\u003eA history of previous cervical spine surgery\u003c/p\u003e\u003cp\u003eDocumented cervical spine trauma or infection\u003c/p\u003e\n\u003ch3\u003eGroups:\u003c/h3\u003e\n\u003cp\u003eACDF Group (n\u0026thinsp;=\u0026thinsp;20): Underwent conventional ACDF technique\u003c/p\u003e\u003cp\u003eArthroplasty/Hybrid Group (n\u0026thinsp;=\u0026thinsp;20): Underwent arthroplasty for the mobile segments and ACDF for the rigid levels\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eSurgical Techniques\u003c/h2\u003e\u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\u003ch2\u003eACDF Protocol:\u003c/h2\u003e\u003cp\u003eStandard right-sided anterior cervical approach\u003c/p\u003e\u003cp\u003eCaspar pin application for distraction\u003c/p\u003e\u003cp\u003eComplete discectomy with thorough posterior osteophyte resection\u003c/p\u003e\u003cp\u003eImplantation of polyetheretherketone (PEEK) interbody cage\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\n\u003ch3\u003eArthroplasty/Hybrid Protocol:\u003c/h3\u003e\n\u003cp\u003eIdentical initial surgical exposure\u003c/p\u003e\u003cp\u003ePrecise endplate preparation preserving subchondral bone integrity\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eProsthesis Implantation:\u003c/h2\u003e\u003cp\u003eDynamic cage for arthroplasty cases\u003c/p\u003e\u003cp\u003eHybrid: ACDF performed at the most degenerated level\u0026thinsp;+\u0026thinsp;arthroplasty at the adjacent level\u003c/p\u003e\u003c/div\u003e\n\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eOutcome Assessment\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;\u003cstrong\u003ePrimary endpoints:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Cervical lordosis: measured by Cobb\u0026apos;s angle\u003cbr\u003e\u0026nbsp;Range of Motion (ROM): Measured by goniometry\u003cbr\u003e\u0026nbsp;Adjacent Segment Degeneration (ASD): Defined by:\u003cbr\u003e\u0026nbsp;New disc height reduction exceeding 30%\u003cbr\u003e\u0026nbsp;Osteophyte formation greater than 2mm\u003cbr\u003e\u0026nbsp;Development of endplate sclerosis\u003cbr\u003e\u0026nbsp;Modified Orthopedic Japanese Association score (mOJA) assessment\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSecondary endpoints:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Neck Disability Index (NDI)\u003cbr\u003e\u0026nbsp;Visual Analog Scale (VAS) for neck and arm pain severity\u003cbr\u003e\u0026nbsp;Operative duration and intraoperative blood loss\u003cbr\u003e\u0026nbsp;Perioperative and postoperative complication incidence\u003c/li\u003e\n\u003c/ol\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eStatistical evaluation utilized SPSS v28 (IBM Corp).\u0026sup1;\u0026sup3; Independent t-tests compared continuous variables; chi-square or Fisher's exact tests analyzed categorical variables. Statistical significance was predefined as p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Power analysis confirmed 80% power for detecting a 5\u0026deg; difference in ROM.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eCollective Outcome Summary\u003c/h2\u003e\u003cp\u003e\u003cb\u003eTable\u0026nbsp;(1): Summary of key outcomes (presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or number (%))\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParameter\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eACDF Group (n\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eArthroplasty/Hybrid (n\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSignificance\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCobb\u0026rsquo;s angle change (\u0026deg;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.73\u0026thinsp;\u0026plusmn;\u0026thinsp;1.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.196\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNot significant\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAdjacent Segment Deg/Disease\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e5 (25%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e2 (10%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.042\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eSignificant\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlood Loss (mL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50.3\u0026thinsp;\u0026plusmn;\u0026thinsp;14.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56.1\u0026thinsp;\u0026plusmn;\u0026thinsp;11.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.164\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNot significant\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComplications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNot significant\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHospital Stay (days)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.512\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNot significant\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emJOA Score (Preop)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.458\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNot significant\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emJOA Score (Postop)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.628\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNot significant\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eROM C2-C7 (\u0026deg;) Preop\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e58.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58.1\u0026thinsp;\u0026plusmn;\u0026thinsp;7.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.967\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNot significant\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eROM C2-C7 (\u0026deg;) Postop\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e44.8\u0026deg;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e54.0\u0026deg;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eSignificant\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVAS Neck Pain (Preop)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.799\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNot significant\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eVAS Neck Pain (Postop)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e5.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e3.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eSignificant\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOperative time (min)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e105\u0026thinsp;\u0026plusmn;\u0026thinsp;15\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e118\u0026thinsp;\u0026plusmn;\u0026thinsp;18\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.03\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eSignificant\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003cp\u003eNote: Statistically significant differences identified for: Postoperative ROM, Postoperative Neck Pain, ASD, and Operative Time\u003c/p\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003ePatient Demographics\u003c/h2\u003e\u003cp\u003e\u003cb\u003eTable\u0026nbsp;(2): Patients' demographic data\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eACDF (n\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eArthroplasty/Hybrid (n\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e52.3\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50.8\u0026thinsp;\u0026plusmn;\u0026thinsp;5.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.42\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale Gender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (65%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (60%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.75\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eRadiographic Outcomes\u003c/h2\u003e\u003cp\u003eBoth ACDF and arthroplasty have shown significant improvements in cervical lordosis, as indicated by increases in Cobb's angle (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for each). Nevertheless, the difference in enhancement between the two methods was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.196). These results align with Park et al.'s findings⁸ but contrast with Barbagallo et al.'s report of greater lordosis correction in hybrid constructs. ⁹ (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e3\u003c/span\u003e) Table\u0026nbsp;(1)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eAdjacent Segment Degeneration (ASD)\u003c/h2\u003e\u003cp\u003eASD incidence was significantly higher in the ACDF group (25%) relative to the arthroplasty/hybrid group (10%, p\u0026thinsp;=\u0026thinsp;0.042). This 2.5-fold reduction in risk aligns with Gao et al.'s meta-analysis and supports the biomechanical premise that motion preservation reduces stress on adjacent segments. ⁴ (Fig.\u0026nbsp;1)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eRange of Motion (ROM) Preservation\u003c/h2\u003e\u003cp\u003eThe arthroplasty/hybrid cohort maintained significantly greater cervical ROM postoperatively (54.0\u0026deg; \u0026plusmn; 5.4\u0026deg;) compared to the ACDF group (44.8\u0026deg; \u0026plusmn; 4.8\u0026deg;, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This 20.5% superiority in motion preservation exceeds Zhao et al.'s reported 15.3% advantage\u0026sup1;⁴ and mirrors Davis et al.'s 4-year CDA outcomes. ⁴(Fig.\u0026nbsp;2)\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003eFunctional Outcomes (NDI and mJOA Scores)\u003c/h2\u003e\u003cp\u003eFunctional improvements were comparable between cohorts, with no significant differences in final NDI scores (ACDF: 35.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2 vs. arthroplasty/hybrid: 31.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9, p\u0026thinsp;=\u0026thinsp;0.09) or mJOA scores (ACDF: 13.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9 vs. arthroplasty/hybrid: 13.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2, p\u0026thinsp;=\u0026thinsp;0.628). These functional equivalence findings are consistent with the 2-year outcomes reported by Davis et al.⁴ and large database analyses.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003eOperative Metrics\u003c/h2\u003e\u003cp\u003e\u003cb\u003eTable\u0026nbsp;(3): Operative metrics\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParameter\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eACDF\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eArthroplasty/Hybrid\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOperative time (min)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e105\u0026thinsp;\u0026plusmn;\u0026thinsp;15\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e118\u0026thinsp;\u0026plusmn;\u0026thinsp;18\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlood loss (ml)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e65\u0026thinsp;\u0026plusmn;\u0026thinsp;22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e72\u0026thinsp;\u0026plusmn;\u0026thinsp;25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.32\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHospital stay (days)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.21\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\u003ch2\u003eInterpretation of the Results\u003c/h2\u003e\u003cp\u003eThis study demonstrates motion-preserving techniques achieve significantly superior preservation of physiological cervical motion compared to ACDF. The arthroplasty/hybrid cohort retained 92.9% of preoperative ROM versus 77.2% in the ACDF group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This kinematic preservation correlated with a significant reduction in ASD risk (10% vs. 25%; p\u0026thinsp;=\u0026thinsp;0.042), supporting the biomechanical premise favoring motion preservation 9. The moderately longer operative time for motion-preserving techniques, while statistically significant, is not considered clinically prohibitive and aligns with the added technical complexity of the procedures.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec27\" class=\"Section2\"\u003e\u003ch2\u003eClinical Implications\u003c/h2\u003e\u003cdiv id=\"Sec28\" class=\"Section3\"\u003e\u003ch2\u003ePatient Selection Factors\u003c/h2\u003e\u003cp\u003eArthroplasty: Ideal for younger individuals (\u0026lt;\u0026thinsp;50 years) who demonstrate intact facet joint integrity\u003c/p\u003e\u003cp\u003eACDF: Appropriate for cases involving osteoporosis, deformities, or situations with economic constraints\u003c/p\u003e\u003cp\u003eHybrid Approach: Advantageous for multilevel conditions that exhibit varying degrees of degeneration.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec29\" class=\"Section2\"\u003e\u003ch2\u003eTechnical Recommendations\u003c/h2\u003e\u003cp\u003eCareful preparation of the endplate is crucial for the success of arthroplasty. Hybrid constructs should focus on achieving fusion at the levels that are most degenerated. The ACDF remains valuable in revision situations. The biomechanical advantages of hybrid constructs, particularly in reducing stress on adjacent segments, are supported by finite element analyses.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy Limitations\u003c/h3\u003e\n\u003cp\u003eThere is an inherent selection bias linked to the retrospective nature of the methodology. The limited sample size hinders comprehensive subgroup comparisons. The follow-up period is inadequate for a conclusive long-term evaluation of ASD and revision surgery rates, which are critical for understanding the full impact of these procedures.\u003c/p\u003e\u003cdiv id=\"Sec31\" class=\"Section2\"\u003e\u003ch2\u003eFuture Research Directions\u003c/h2\u003e\u003cp\u003eLong-term studies (\u0026ge;\u0026thinsp;10 years) are needed to assess the durability of arthroplasty implants and true revision rates. Economic evaluations should analyze cost effectiveness across various healthcare systems, especially given the higher implant costs of motion-preserving technologies. There is a need to identify biomarkers that can predict successful motion preservation. Advanced imaging studies should explore segmental biomechanics following surgery.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis comparative study demonstrates that arthroplasty and hybrid techniques offer enhanced motion preservation and a significantly reduced risk of adjacent segment disease (ASD: 10% vs. 25%) compared to the ACDF method, while achieving similar short-term clinical results with only a moderately longer operative time. The ACDF technique remains a dependable choice with well-established long-term effectiveness, especially in scenarios with budget constraints or complex anatomical challenges. Surgeries that preserve motion provide significant benefits for younger patients who prioritize the maintenance of cervical kinematics. Hybrid techniques serve as a practical compromise for addressing multilevel degeneration. These results support the need for personalized surgical decisions based on patient age, anatomical considerations, and functional needs. Future studies with longer follow-up are required to evaluate long-term outcomes and economic assessments to further enhance treatment protocols.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003cp\u003e Consent to Publish\u003c/p\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003cp\u003eEthics and Consent to Participate\u003c/p\u003e\u003cp\u003eEthics and Consent to Participate declarations: not applicable (retrospective study, anonymized data).\u003c/p\u003e\u003cp\u003eData Availability\u003c/p\u003e\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\u003cp\u003eCompeting Interests\u003c/p\u003e\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMohamed Tammam: Conceptualization, Methodology, Project Administration, Writing \u0026ndash; Original Draft Preparation, Writing \u0026ndash; Review \u0026amp; Editing.Abdalla Ragab: Formal Analysis, Investigation, Data Curation, Writing \u0026ndash; Original Draft Preparation.Mahmoud Ammar: Resources, Validation, Supervision, Writing \u0026ndash; Review \u0026amp; Editing.All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSmith GW, Robinson RA. The treatment of certain cervical spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am. 1958;40(3):607-624.\u003c/li\u003e\n\u003cli\u003eHilibrand AS, Carlson GD, Palumbo MA, et al. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am. 1999;81(4):519-528.\u003c/li\u003e\n\u003cli\u003eZhao Y, Zhang Y, Sun Y, et al. Comparison of cervical disc arthroplasty and anterior cervical discectomy and fusion for the treatment of cervical disc degenerative diseases: a meta-analysis of randomized controlled trials. Spine. 2020;45(17):E1066-E1074.\u003c/li\u003e\n\u003cli\u003eDavis RJ, Nunley PD, Kim KD, et al. Two-level total disc replacement with Mobi-C cervical artificial disc versus anterior discectomy and fusion: a prospective, randomized, controlled multicenter clinical trial with 4-year follow-up results. J Neurosurg Spine. 2015;22(1):15-25.\u003c/li\u003e\n\u003cli\u003eBarbagallo GMV, Corbino LA, Olindo G, et al. Hybrid surgery in multilevel cervical degenerative disc disease: 5-year follow-up. Eur Spine J. 2018;27(6):1339-1349.\u003c/li\u003e\n\u003cli\u003eMummaneni PV, Burkus JK, Haid RW, et al. Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion: a randomized controlled clinical trial. J Neurosurg Spine. 2007;6(3):198-209.\u003c/li\u003e\n\u003cli\u003eGao Y, Liu M, Li T, et al. A meta-analysis comparing the results of cervical disc arthroplasty with anterior cervical discectomy and fusion (ACDF) for the treatment of symptomatic cervical disc disease. J Bone Joint Surg Am. 2013;95(6):555-561.\u003c/li\u003e\n\u003cli\u003ePark DK, Lin EL, Phillips FM. Index and adjacent level kinematics after cervical disc replacement and anterior fusion: in vivo quantitative radiographic analysis. Spine. 2011;36(9):721-730.\u003c/li\u003e\n\u003cli\u003eMcAfee PC, Cappuccino A, Cunningham BW, et al. Lower incidence of dysphagia with cervical arthroplasty compared with ACDF in a prospective randomized clinical trial. J Spinal Disord Tech. 2010;23(1):1-8.\u003c/li\u003e\n\u003cli\u003eAment JD, Yang Z, Nunley P, et al. Cost-effectiveness of cervical total disc replacement vs fusion for the treatment of 2-level symptomatic degenerative disc disease. JAMA Surg. 2014;149(12):1231-1239.\u003c/li\u003e\n\u003cli\u003eWu T-K, Wang B-Y, Cheng D, et al. Prospective randomized comparison of cervical total disc replacement vs anterior cervical discectomy and fusion: results at 48 months follow-up. J Neurosurg Spine. 2020;33(5):560-566.\u003c/li\u003e\n\u003cli\u003eBurkus JK, Haid RW, Traynelis VC, et al. Long-term clinical and radiographic outcomes of cervical disc replacement with the Prestige LP disc: results from a prospective randomized controlled clinical trial. J Neurosurg Spine. 2014;20(6):675-687.\u003c/li\u003e\n\u003cli\u003eLu VM, Mobbs RJ, Phan K. Hybrid surgery for multilevel cervical degenerative disc disease: a systematic review of biomechanical and clinical evidence. J Clin Neurosci. 2017;38:83-86.\u003c/li\u003e\n\u003cli\u003eZhao Y, Wang Y, Chang H, et al. Cervical disc arthroplasty versus fusion for single-level symptomatic cervical disc disease: a meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg. 2022;142(7):1091-1102.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"ACDF, cervical arthroplasty, hybrid surgery, Smith-Robinson technique, adjacent segment degeneration","lastPublishedDoi":"10.21203/rs.3.rs-7504877/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7504877/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Cervical disc prolapse frequently causes radiculopathy and myelopathy. The Smith-Robinson anterior cervical discectomy and fusion (ACDF) technique, established in 1958, remains widely used with its modifications. Motion-preserving surgical alternatives aim to minimize adjacent segment degeneration (ASD). This study compares ACDF with arthroplasty and hybrid procedures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This retrospective cohort study analyzed 40 patients with cervical discs prolapse, assigned to ACDF (n=20) or arthroplasty/hybrid groups (n=20). Primary outcomes assessed at 12-month follow-up included Cobb's angle assessment, cervical range of motion (ROM), ASD incidence, Neck Disability Index (NDI), and complications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The arthroplasty/hybrid group exhibited significantly superior ROM preservation (54.0° vs. ACDF 44.8°; p\u0026lt;0.001) and reduced ASD occurrence (10% vs. 25%; p=0.042). Functional outcomes demonstrated comparable NDI improvement (arthroplasty/hybrid: 31.2 vs. ACDF: 35.8; p=0.09). Arthroplasty/hybrid procedures required moderately longer operative durations (118±18 vs. 105±15 minutes; p=0.03). Complication profiles were similar (5% each).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Motion-preserving surgical methods yield superior biomechanical results, including decreased ASD risk, relative to ACDF, while achieving equivalent short-term clinical efficacy. The established Smith-Robinson technique remains effective, but arthroplasty/hybrid approaches present advantages for maintaining segmental motion.\u003c/p\u003e","manuscriptTitle":"Cervical Disc Arthroplasty and Hybrid Surgery Versus Anterior Cervical Discectomy and Fusion in the Treatment of Single and Multiple Cervical Disc Prolapse: A Comparative Reliability Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-08 10:00:05","doi":"10.21203/rs.3.rs-7504877/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8b1d0da7-add3-45a4-8b2c-86c0f5490b54","owner":[],"postedDate":"October 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-30T06:40:55+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-08 10:00:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7504877","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7504877","identity":"rs-7504877","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}