Objective:

To compare the safety and efficacy of two types of hybrid surgery (HS1 and HS2) and anterior cervical discectomy and fusion (ACDF) for three-level cervical degenerative disease (CDD).

Approach:

• Study Design: Systematic review and network meta-analysis conducted according to PRISMA guidelines.
• Data Sources: Comprehensive search of Web of Science Core Collection, PubMed, and Embase from inception to December 19, 2025.
• Inclusion Criteria: Studies involving patients with clinically confirmed three-level CDD, comparing safety and outcomes of ACDF, HS1, and HS2.

Key Findings:

• HS1 resulted in a significantly lower Neck Disability Index (NDI) compared to ACDF.
• C2-7 range of motion (ROM) was significantly greater in HS1 and HS2 than in ACDF.
• HS1 had a significantly lower C2-7 ROM compared to HS2.
• ROMs of upper and lower segments in HS1 and HS2 were significantly lower than in ACDF.
• No significant difference in ROM of upper or lower segments between HS1 and HS2.

Interpretation:

HS1, HS2, and ACDF are all safe and effective options for three-level CDD, with HS1 and HS2 better preserving C2-7 ROM compared to ACDF.

Limitations:

• Limited number of studies included in the meta-analysis.
• Variability in study designs and patient populations.

Conclusion:

HS1 and HS2 may offer advantages in preserving cervical motion compared to ACDF, with similar incidences of adjacent segment degeneration.

Sources:

• Systematic Review Registration