Introduction: To report the clinical outcomes in patient undergoing 3- and 4-level anterior cervical discectomy and fusion (ACDF)
Methods: We retrospectively reviewed adult neurosurgical patients who underwent elective ACDF at a single institution by a single surgeon between 2004 and 2016. None of the patients underwent corpectomy. We investigated the following clinical outcomes: perioperative complications, need for revision, presence of symptoms on last follow up.
Results: Fifty four patients underwent 3-level and 51 patients underwent 4-level ACDF with mean follow up of 2.7 ± 1.9 years. The patients did not differ based on their baseline demographic variables and medical comorbidities which included diabetes, hypertension, obesity, smoking status. The two groups had similar presenting symptoms the most common of which were neck pain followed by sensory deficits. Patients with 4-level fusion were more likely than 3-level fusion to have estimated blood loss >100ml (p=0.04). Perioperatively, none of the patients, in neither group, experienced wound infection, vertebral artery injury, laryngeal nerve palsy, durotomy or esophageal perforation. One patient in each group experienced postoperative hematoma, which did not require surgical intervention. Dysphagia was the most perioperative complication at 18% in the 3-level and 14% in the 4-level fusion (p=0.61). Two patients in each group underwent revision surgery (3.7% vs 3.9%, p>0.05). At the last follow up, the most common symptom was neck pain followed by sensory deficits. The two groups did not differ with regard to symptoms at the time of last follow up.
Conclusions: : In this study, there were no significant difference between patients who underwent 3- and 4-level ACDF in terms of perioperative complications, the need for revision surgery, or persistent symptoms on last follow up. Patients with 4 level fusion had more blood loss which is expected. The rate of complications in our series is similar to those reported for 1- and 2-level ACDF’s. Thus, 3- and 4-level ACDF’s are not inherently associated with more complications and can be performed safely with similar risk profile as shorter fusion constructs.
Patient Care: Clinical outcomes of 3- and 4-level ACDF are comparable to each other and to 1- or 2-level ACDF, as historically reported. The results of the study helps with counseling patients appropriately should they require a larger ACDF construct.
Learning Objectives: understand the common complications associated with ACDF
Appreciate the rate of complications in 3- and 4-level ACDF
Understand the clinical outcomes of 3- and 4-level ACDF are similar