Comparison of skip-level ACDF vs. contiguous ACDF in the treatment of skip-level cervical degenerative disease: a systematic review and meta-analysis.

BACKGROUND: The selection of surgical regimens for skip-level cervical degenerative disease (CDD) has long been controversial, with a core focus on whether intact intervertebral discs at intermediate levels should be preserved. This systematic review and meta-analysis compared the clinical and radiological outcomes as well as complication rates between skip-level anterior cervical discectomy and fusion (ACDF) and contiguous ACDF for skip-level CDD. METHODS: This systematic review and meta-analysis was performed in accordance with the PRISMA 2020 Statement. The PubMed, Web of Science core collection, Embase (via Ovid), CNKI and WanFang databases were systematically searched from inception to November 30, 2025. This systematic review and meta-analysis was conducted via Review Manager 5.3. RESULTS: Five studies with 116 patients in the skip-level ACDF group and 158 patients in the contiguous ACDF group were included. The surgical time [MD: -42.18, 95% CI (-50.91, -33.45), I2 = 72%] and intraoperative blood loss [MD: -28.89, 95% CI (-33.63, -24.14), I2 = 78%] were significantly lower in the skip-level ACDF group than in the contiguous ACDF group. No significant differences in the JOA score, C2-7 ROM, C2-7 SVA, T1 slope, complication rate or adjacent segment degeneration were detected between the two groups. CONCLUSION: Current evidence suggests that skip-level ACDF can reduce surgical time and intraoperative blood loss. Current evidence does not reveal a statistically significant increase in adjacent segment degeneration following skip-level ACDF. However, the available evidence remains limited. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251243686, Identifier CRD420251243686.