Introduction: Anterior cervical discectomy and fusion (ACDF) demonstrates reliable improvement in neurologic symptoms associated with anterior compression of the cervical spine. There is a paucity of data on outcomes following 4-level ACDFs. Our aim was to review the outcome of 42 consecutive patients who underwent instrumented 4-levels ACDF and plating and were followed up for at least 6 months.
Methods: Records of 27 men and 15 women aged 40 to 83 years who underwent instrumented 4-levels ACDF and plating for myeloradiculopathy (n=20), radiculopathy (n=13) or myelopathy (n=9) at C3 to C7 (n=39) or C4 to T1 (n=3) by a single surgeon and were followed-up for a minimum of 6 months were reviewed. Clinical outcome was assessed using the visual analogue scale (VAS) for pain, Odom’s criteria, improvement of symptoms, intra- & post-operative complications, and need for revision surgery.
Results: The mean follow-up was 50 months. All patients who had weakness pre-operative (n=26) had a good recovery of motor power except 4. The mean VAS for arm and neck pain improved from 8.8 to 4.8. Concerning the Odom’s criteria, 14 were excellent, 14 were good, 12 were fair and 2 was bad. Concerning intra- and post-operative complications there were 10 cases developed dysphagia (all improved by 3 months and one patient developed dysphagia 2 months’ post-surgery), 3 cases developed temporary dysphonia, 2 cases developed post-operative hematoma and the wound was opened to evacuate the hematoma, one vertebral artery injuries with no neurological consequences, one patient developed C5 palsy and one case had superficial wound infection (treated by dressing and antibiotics). The average length of stay was 3.3 days. 8 patients needed another surgery (1 adjacent segment and 7 posterior foraminotomies).
Conclusions: Instrumented 4-levels ACDF and plating are safe and effective for multilevel cervical spondylosis and achieve a satisfactory outcome.
Patient Care: Decrease the rate of the future redo surgery for adjacent segment disease with less risks of complication of the redo surgeries.
Learning Objectives: By the conclusion of this session, participants should be able to know that Instrumented 4-levels ACDF and plating are safe and effective for multilevel cervical spondylosis and achieve a satisfactory outcome.