In gratitude of the loyal support of our members, the CNS is offering complimentary 2021 Annual Meeting registration to all members! Learn more.

  • Fusion Rate, Dysphagia and Patient Satisfaction for 4-Level Anterior Cervical Discectomy and Fusion (ACDF)

    Final Number:

    Richard F Cook DO; Ratnesh Mehra D.O.; Doris Tong MD; Teck-Mun Soo MD; Lee Sandquist DO

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: The literature on ACDF> 3 levels remains controversial. Combined anterior posterior cervical fusion leads to increased morbidity and loss of cervical mobility. We investigated fusion rate, incidence of dysphagia and patient satisfaction in 4-level ACDF in order to demonstrate that multi-level ACDF >3 levels is a reasonable option.

    Methods: Radiographic and chart review were done for consecutive patients who underwent elective 4-level ACDF from 2006-2011. Fusion rate was evaluated for patients with postoperative cervical radiographs/CT at 6 months or more. We excluded patients with a planned staged anterior-posterior cervical fusion. Fusion is determined by neuroradiologists who evaluated post-operative standing radiographs and CT. The criteria are lucency around the hardware, absence of spinous process movement on flexion/extension films, and bone bridging.Patients completed a dysphagia and satisfaction survey by phone. Descriptive statistics were used.

    Results: Ninety-three patients were included in the study. Eighty-two patientshad postoperative imaging at 6 months or more. There were a total of 328 interspaces; 316 interspaces were adequate for fusion evaluation. Ten interspaces either had failed fusion or indeterminate fusion status. Fusion rate per interspace is 96.8%. Seventy-seven patients had successful fusion. Fusion rate per patient is 93.9%. Patient satisfaction surveys were completed in 60 out of 93 (64.5%)patients. Fifty-three(88%) out of 60 patients were satisfied with the results of the surgery. Postoperative dysphagia resolved within 4-30 days with an average of 13 days. All patients surveyed regained normal swallowing function.

    Conclusions: Four-level ACDF achieves a very high fusion rate in our institution with a very high satisfaction rate and comparable dysphagia rate. ACDF has proved to be a viable alternative for patients with surgical pathology of >3 levels.

    Patient Care: We demonstrate that ACDF has proved to be a viable alternative for patients with surgical pathology of >3 levels

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the need and importance of acheiving fusion in 4 level ACDF 2) Discuss, in small groups what constitutes "acceptable fusion" 3) Identify pseudoarthrosis in ACDF, completed fusion and desirable end results after multi-level ACDF

    References: 1. Chang et al. Neurosurgery, 2010 Four level anterior cervical discectomy and fusion with plate fixation: Radiographic and clinical results 2. Bolestra et al. Spine, 2000 Three and Four level ACDF with plate fixation 3. Koller et al. Eur Spine, 2007 4- and 5-level anterior fusions of the cervical spine: review of literature and clinical results 4. Vukic et al. Coll. Anthropol., 2011 Hydroxyapatite Ceramics in Multilevel Cervical interbody Fusion – Is There a Role? 5. Shousha et al. Eur Spine, 2012 Four-level anterior cervical discectomies and cage-augmented fusion with and without fixation 6. Hwang et al. J Neurosurg (Spine), 2004 Three-level and four-level anterior cervical discectomies and titanium cage-augmented fusion with and without plate fixation

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy