pseudarthrosis in multilevel ACDF procedures, further efforts are needed to increase the arthrodesis rate of the primary surgery. Due to the high pseudarthrosis rates in these procedures, a combined anterior-posterior approach is commonly considered, 11 and while it is a viable option, there is a significant increase in morbidity associated with this procedure. Studies have suggested an overall complication rate of approximately 69% in the perioperative period, 12 , 13 with postoperative dysphagia occurring in 30%–50% of cases. 12 , 14 , 15 In patients undergoing complex
Alec W. Gibson, Abdullah H. Feroze, Madeline E. Greil, Margaret E. McGrath, Sananthan Sivakanthan, Gabrielle A. White-Dzuro, John R. Williams, Christopher C. Young, and Christoph P. Hofstetter
Daniel C. Lu, Luis M. Tumialán, and Dean Chou
fixation between 2002 and 2006 in one institution (Emory University). As a 2:1–ratio control cohort, 50 patients who had undergone multilevel ACDF were matched in surgical levels, number of levels, smoking status, and age to the study population. Patients in the rhBMP-2 cohort were consecutively chosen. The patients in the control cohorts were matched for the number of levels of ACDF performed and by the date of operation. The patients in the control allograft cohort underwent surgery at UCSF between 2005 and 2007. The clinical and radiographic records of these cases
Praveen V. Mummaneni, Michael G. Kaiser, Paul G. Matz, Paul A. Anderson, Michael W. Groff, Robert F. Heary, Langston T. Holly, Timothy C. Ryken, Tanvir F. Choudhri, Edward J. Vresilovic, and Daniel K. Resnick
techniques (quality of evidence, Class III; strength of recommendation, D). If anterior fixation is not used, it is recommended that ACCF be considered before ACDF because it may provide a higher fusion rate than multilevel ACDF. It should be understood that the use of ACCF is associated with higher graft failure rates than multilevel ACDF (quality of evidence, Class III; strength of recommendation, D). Technique: ACDF or ACD Versus Laminectomy There is insufficient evidence to recommend ACD or ACDF over laminectomy in the near term because both approaches have
Zoe E. Teton, Barry Cheaney II, James T. Obayashi, and Khoi D. Than
occurrence of pseudarthrosis of PEEK devices versus structural allograft in patients who underwent multilevel ACDF. This is the first study, to our knowledge, to compare pseudarthrosis and reoperation rates in a large cohort of patients who underwent multiple-level ACDF. Methods In this retrospective, single-center study, all consecutive ACDF procedures from July 2011 to November 2017 were reviewed. Thirteen different attending surgeons (10 neurological surgeons and 3 orthopedic surgeons) performed the operative procedures. Patients undergoing a single-level ACDF and
Syed I. Khalid, Ryan Kelly, Rita Wu, Akhil Peta, Adam Carlton, and Owoicho Adogwa
) ACDF performed in an outpatient setting. 9 , 18 This may be because multilevel ACDF has been shown to have greater rates of complications and 30-day readmissions as the number of segments fused increases. 6 , 7 , 11 , 33 Previous studies have also typically focused on the overall adult population, with average age of patients being around 50 years old, 1 , 9 , 17 , 24 and few have specifically assessed the geriatric population. The geriatric population presents interesting and important considerations regarding the increased rates of postoperative complications
Vincent C. Traynelis, Jonathan Sherman, Eric Nottmeier, Vaneet Singh, Kirk McGilvray, Christian M. Puttlitz, and Patrick Devin Leahy
- and 3-level fusion success rates reported to be 82%–95% and 63%–83%, respectively. 7 , 12 , 18 Overall, it is widely accepted that reduction in motion at the fusion site, which is most frequently accomplished with instrumentation, generally decreases the risk of nonunion. However, imparting adequate rigidity to a multilevel ACDF construct to achieve a successful fusion in the relatively mobile cervical spine is challenging. Almost all ACDF procedures use both intervertebral disc spacers (allografts or synthetic biomaterial) and anterior plates with screw fixation
Joseph B. Stachniak, Jeffrey D. Diebner, Estee S. Brunk, and Shelley M. Speed
used. In contrast, we were able to show consistency of dose from assay analysis with all patients receiving a 0.4-ml sponge soaked with 0.6 mg of rhBMP-2 per level. In the study by Smucker et al., the rhBMP-2 group was more likely to have undergone a multilevel ACDF than the non–rhBMP-2 group. Even after controlling for potential confounding variables, patients receiving rhBMP-2 were 10.1 times more likely to experience soft-tissue swelling than those who did not receive it. Smucker and associates were among the first to accurately describe a time window for the
Christopher C. Gillis, Megan C. Kaszuba, and Vincent C. Traynelis
SVA is not as reliable as 1-year cervical SVA for observing the amount of sagittal correction achieved. This establishes a baseline for further examination of the ability of multilevel ACDF to achieve cervical deformity correction through the intervertebral correction of lordosis. References 1 Ames CP , Blondel B , Scheer JK , Schwab FJ , Le Huec JC , Massicotte EM , : Cervical radiographical alignment: comprehensive assessment techniques and potential importance in cervical myelopathy . Spine (Phila Pa 1976) 38 : 22 Suppl 1 S149 – S160
Bryan Barnes, Regis W. Haid, Gerald Rodts, Brian Subach, and Michael Kaiser
The authors present a retrospective review of 77 patients in whom they performed anterior cervical discectomy and fusion (ACDF) in the treatment of radiculopathy and/or myelopathy. In all cases anterior interbody fusion was performed using the Atlantis locking plate system to treat the degenerative disease.
There were 41 men and 36 women (mean age 53.8 years), and 24 active cigarette smokers (31%) in the group. All patients presented with signs and symptoms of cervical radiculopathy and/or myelopathy, and magnetic resonance imaging or computerized tomography myelography demonstrated evidence of radicular and/or spinal cord compression at one or more cervical levels. Thirty-one patients underwent single-level ACDF, 20 patients underwent multilevel ACDF without posterior instrumentation, in eight patients one- to four-level corpectomies were supplemented with posterior fixation, 12 patients underwent single-level corpectomy, and six patients underwent multilevel corpectomy with no posterior instrumentation. The mean follow-up period was 15.33 months; overall good-to-excellent outcome was seen in 75% of patients; osseous fusion was demonstrated in 93.5%. In all patients except three, fibular allograft was used as graft material.
The degree of overall cervical lordosis was measured at the last follow up and was compared with normal values obtained in age-matched individuals. In addition, the degree of cervical lordosis at fusion levels was compared with overall cervical lordosis. In patients in all five of the aforementioned categories significantly less lordosis was demonstrated than in age-matched controls. In patients who underwent single-level ACDF, single-level corpectomy, and multilevel ACDF significantly less lordosis was observed at the fusion segment than that in the overall cervical spine.
Complications included one episode of chronic anterior wound drainage treated with intravenous antibiotic medication and one postoperative posterior wound infection, which required reoperation and intravenous antibiotic medication. Two cases (2.6%) of anterior screw backout and/or breakage were identified. One patient died of unrelated causes within 3 months of operation.
These initial results indicate that use of the Atlantis plate system for anterior cervical arthrodesis produces fusion rates and clinical outcomes that are comparable with those obtained using other locking plating systems. It has the unique advantage, however, of providing the surgeon with the choice of fixed, variable, or hybrid screw constructs as a way of tailoring screw angles to individual anatomical/biomechanical needs.
Luis M. Tumialán, Jeff Pan, Gerald E. Rodts Jr., and Praveen V. Mummaneni
The goal in this study was to demonstrate the safety and efficacy of anterior cervical discectomy and fusion ([ACDF]; single- or multilevel procedure) performed using titanium plates and polyetheretherketone (PEEK) spacers filled with recombinant human bone morphogenetic protein–2 (rhBMP-2) impregnated in a type I collagen sponge to achieve fusion.
The authors retrospectively reviewed 200 patients who underwent a single- or multilevel ACDF with titanium plate fixation and PEEK spacer filled with a collagen sponge impregnated with low-dose rhBMP-2. Clinical outcomes were assessed using pre- and postoperative Nurick grades and the Odom criteria. Radiographic outcomes were assessed using dynamic radiographs and computed tomography (CT) scans.
The follow-up period ranged from 8 to 36 months (mean 16.7 months). A single-level ACDF was performed in 96 patients, 2-level ACDF in 62 patients, 3-level ACDF in 36 patients, and 4-level ACDF in 6 patients. Long-term follow-up was available for 193 patients. The Odom outcomes were rated as good to excellent in 165 patients (85%), fair in 24 (12.4%), and poor in 4 (2%). Among patients with myelopathy, Nurick grades improved from a preoperative mean of 1.42 to a postoperative mean of 0.26. All patients (100%) achieved solid radiographic fusion on dynamic radiographs and CT scans. Fourteen patients (7%) in this series experienced clinically significant dysphagia, and 4 (2%) required repeated operation for hematoma or seroma.
An ACDF performed using a PEEK spacer filled with rhBMP-2 leads to good to excellent clinical outcomes and solid fusion, even in multilevel cases and in patients who are smokers. The incidence of symptomatic dysphagia may be decreased with a lower dose of rhBMP-2 that is placed only within the PEEK spacer.