A single-center retrospective analysis of 3- or 4-level anterior cervical discectomy and fusion: surgical outcomes in 66 patients

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  • 1 Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia; and
  • 2 Department of Neurosurgery, Duke University, Durham, North Carolina
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OBJECTIVE

Anterior cervical discectomy and fusion (ACDF) is a safe and effective intervention to treat cervical spine pathology. Although these were originally performed as single-level procedures, multilevel ACDF has been performed for patients with extensive degenerative disc disease. To date, there is a paucity of data regarding outcomes related to ACDFs of 3 or more levels. The purpose of this study was to compare surgical outcomes of 3- and 4-level ACDF procedures.

METHODS

The authors performed a retrospective chart review of patients who underwent 3- and 4-level ACDF at the University of Virginia Health System between January 2010 and December 2017. In patients meeting the inclusion/exclusion criteria, demographics, fusion rates, time to fusion, and reoperation rates were evaluated. Fusion was determined by < 1 mm of change in interspinous distance between individual fused vertebrae on lateral flexion/extension radiographs and lack of radiolucency between the grafts and vertebral bodies. Any procedure requiring a surgical revision was considered a failure.

RESULTS

Sixty-six patients (47 with 3-level and 19 with 4-level ACDFs) met the inclusion/exclusion criteria of having at least one lateral flexion/extension radiograph series ≥ 12 months after surgery. Seventy percent of 3-level patients and 68% of 4-level patients had ≥ 24 months of follow-up. Ninety-four percent of 3-level patients and 100% of 4-level patients achieved radiographic fusion for at least 1 surgical level. Eighty-eight percent and 82% of 3- and 4-level patients achieved fusion at C3–4; 85% and 89% of 3- and 4-level patients achieved fusion at C4–5; 68% and 89% of 3- and 4-level patients achieved fusion at C5–6; 44% and 42% of 3- and 4-level patients achieved fusion at C6–7; and no patients achieved fusion at C7–T1. Time to fusion was not significantly different between levels. Revision was required in 6.4% of patients with 3-level and in 16% of patients with 4-level ACDF. The mean time to revision was 46.2 and 45.4 months for 3- and 4-level ACDF, respectively. The most common reason for revision was worsening of initial symptoms.

CONCLUSIONS

The authors’ experience with long-segment anterior cervical fusions shows their fusion rates exceeding most of the reported fusion rates for similar procedures in the literature, with rates similar to those reported for short-segment ACDFs. Three-level and 4-level ACDF procedures are viable options for cervical spine pathology, and the authors’ analysis demonstrates an equivalent rate of fusion and time to fusion between 3- and 4-level surgeries.

ABBREVIATIONS ACDF = anterior cervical discectomy and fusion; PSIF = posterior spinal instrumentation and fusion.

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Contributor Notes

Correspondence Avery L. Buchholz: University of Virginia, Charlottesville, VA. alb8jp@hscmail.mcc.virginia.edu.

INCLUDE WHEN CITING Published online October 9, 2020; DOI: 10.3171/2020.6.SPINE20171.

Disclosures Dr. C. Shaffrey has direct stock ownership in NuVasive; is a consultant for NuVasive, Medtronic, and SI Bone; and receives royalties from NuVasive, Medtronic, and Zimmer. Dr. Smith is a consultant for Zimmer Biomet, NuVasive, Stryker, Cerapedics, Astura, and Carlsmed; receives royalties from Zimmer Biomet and NuVasive; receives support of non–study-related clinical or research effort that he oversees from DePuy Synthes/ISSG and AO Spine; receives fellowship funding from NREF and AO Spine; and holds stock in Alphatec. Dr. Yen is a consultant for NuVasive.

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