Full-Endoscopic Posterior Cervical Decompression Versus Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis
Chi-Chin Huang, Yu-San Chen, Yueh-Ying Hsieh, Chang-Jung Chiang, Lien-Chen Wu, Yen-Hsiang Wang, Ting-Shuo HsuStudy design
Systematic review and meta-analysis of randomized controlled trials and cohort studies directly comparing full-endoscopic posterior cervical decompression (PECD) with anterior cervical discectomy and fusion (ACDF) in adults with degenerative cervical disease.
Objective
To compare full-endoscopic posterior cervical decompression with anterior cervical discectomy and fusion for degenerative cervical disease.
Methods
PubMed, Embase, and CENTRAL were searched through September 2025 for randomized and cohort studies in adults with ≥ 6 months’ follow-up directly comparing PECD and ACDF. NDI, VAS neck/arm pain in short-term and long-term follow up, C2–C7 Cobb angle, peri-operative metrics, and adverse events were pooled using random-effects models with 95% confidence intervals.
Results
Ten studies (2 RCTs, 8 cohorts) comprising 862 patients (PECD 433; ACDF 429) with 6 months to 2.5 years of follow-up were included. NDI and VAS arm pain scores did not differ significantly at final follow-up. PECD showed greater short-term functional improvement (NDI MD 2.46, 95% CI 1.55–3.36), whereas ACDF achieved slightly greater long-term neck pain improvement (VAS neck MD −0.24, 95% CI −0.43 to −0.04). C2–C7 Cobb angle and operative time did not differ. PECD was associated with a shorter hospital stay (MD −1.64 days, 95% CI −2.31 to −0.97) and lower blood loss (MD −44.85 mL, 95% CI −79.8 to −9.89), though these perioperative outcomes demonstrated substantial heterogeneity. Additionally, PECD was associated with a significantly lower risk of postoperative complications (RR 0.53, 95% CI 0.34–0.81); whereas ASD and index-level re-operation rate did not differ.
Conclusions
PECD provides comparable mid-term disability and arm pain relief to ACDF with faster early recovery and lower perioperative morbidity, while ACDF offers marginally better long-term axial neck pain improvement.