PURPOSE To compare sagittal alignment and clinical outcomes between three-level hybrid surgery (HS) and anterior cervical discectomy and fusion (ACDF) on cervical spondylotic myelopathy (CSM) over a 5-year follow-up. METHOD The study included 32 patients with ACDF, 36 patients with 1 prosthesis and 2 cages (HS1 group), and 25 cases with 2 prostheses and 1 cage (HS2 group). Alignment parameters included C2-C7 cervical lordosis (CL), C2-C7 sagittal vertical axis (SVA), T1 slope (T1S), and T1S minus CL (T1SCL). Radiographic parameters were range of motion (ROM), upper and lower adjacent ROM (UROM and LROM), and operated-segment lordosis (OPCL), as well as adjacent segment degeneration (ASD). Clinical outcomes included the neck disability index (NDI) and Japanese Orthopedic Association (JOA) score. RESULTS Three groups were well-matched in demographics. All groups gained comparable improvement on NDI and JOA (P < 0.01). All groups gained CL improvement at the final visit (P < 0.05). There were no statistical differences on SVA and T1SCL among the groups and among preoperation, 1 week later, and final follow-up (P > 0.05) while T1S improved at 1 week later and final follow-up with HS2. The final change of all alignment parameters among the three groups was of no differences. ROM decreased and OPCL increased in all groups at the final follow-up (P < 0.05). UROM and LROM increased with ACDF but kept stable with HS1 and HS2. There was no inter-group difference on the incidence of ASD (P > 0.05). CONCLUSION Cervical alignment was comparably improved. HS and ACDF provided identified mid-term efficacy, and it was not necessary to have to use prosthesis on three-level CSM.

中文翻译：

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连续三级混合手术以及颈前路椎间盘切除术和融合术后矢状面对准和临床结果的探索：至少为期5年的随访。

目的比较5年随访的三级混合手术（HS）与颈椎前路椎间盘切除术和融合术（ACDF）治疗颈椎病性脊髓病（CSM）的矢状面对准和临床结果。方法本研究包括32例ACDF患者，36例1个假体和2个笼子（HS1组）和25例2个假体和1个笼子（HS2组）。对齐参数包括C2-C7颈椎前凸（CL），C2-C7矢状纵轴（SVA），T1斜率（T1S）和T1S减去CL（T1SCL）。射线照相参数是运动范围（ROM），上下相邻ROM（UROM和LROM），手术节段前凸（OPCL）以及相邻节段退变（ASD）。临床结果包括颈部残疾指数（NDI）和日本骨科协会（JOA）得分。结果三组在人口统计学上非常匹配。所有组在NDI和JOA方面均取得了相当的改善（P <0.01）。所有组在最终访视时均改善了CL（P <0.05）。各组之间以及术前，术后1周和最终随访之间的SVA和T1SCL无统计学差异（P> 0.05），而在术后1周和HS2最终随访中，T1S改善了。三组中所有比对参数的最终变化无差异。在最后的随访中，所有组的ROM均降低而OPCL升高（P <0.05）。ACDF使UROM和LROM增加，而HS1和HS2保持稳定。ASD的发生率之间没有组间差异（P> 0.05）。结论颈椎对位可比性得到改善。HS和ACDF提供了确定的中期疗效，