Introduction: The anterior cervical discectomy and fusion (ACDF) are one of the most commonly performed surgical procedures on the cervical spine diseases. Overall one and two levels ACDFs are well tolerated compared to three or 4 level ACDFs. However, the outcome data for 3- and specifically 4-level ACDF procedures is lacking in the literature, with concerns raised over their relative safety in comparison to 1- and 2-level procedures. This study aims to provide a comparison of perioperative complications and clinical outcomes data between 4- and 3-level ACDF procedures.
Methods: A retrospective review of all adult neurosurgical patients undergoing elective ACDF for degenerative disc disease at a single institution between 2013 and 2018. The inclusion criteria for the study were patients who underwent first-time 3- or 4-level ACDF. The exclusion criteria were patients lacking 90-day minimum follow-up and those undergoing ACDF following non-elective circumstances. Outcome measures included perioperative complication rates, fusion rates, need for revision surgery, Nurick scores, Odom's criteria, and specific symptom resolution.
Results: Forty-four patients who underwent 3-level ACDF and 21 patients who underwent 4-level ACDF were identified. The 4-level ACDF group was found to have significantly higher mean estimated blood loss and mean procedural duration. No differences were identified between the 4- and 3-level groups regarding perioperative complications, including dysphagia, laryngeal nerve palsy, and infection. All measured outcomes were not significantly different between groups, including the prevalence of post-operative symptomology, revision surgery, Nurick scores, and outcome classification according to Odom's criteria.
Conclusions: Compared to those who underwent 3-level ACDF, patients who underwent 4-level ACDF had only significantly higher mean estimated blood loss and mean procedural duration. No significant differences were found between groups in post-operative symptomology, revision surgery, Nurick scores, or Odom's criteria. These findings suggest 4-level ACDF procedures offer no increased morbidity or worsened outcomes when compared to 3-level procedures.
Patient Care: The research will provide insight into the outcomes of these less common rare procedures, helping guide surgeons to make informed decisions within a patient population that can often suffer from a severe disability due to their condition.
Learning Objectives: "By the conclusion of this session, participants should be able to: 1) recognize and discuss the 4-level ACDF as a safe option for patients with DDD, 2) Discuss the fact the 4-level ACDF does show increased morbidity compared to a 3-level ACDF, 3) Discuss the continued use of multi-level (3 and 4) ACDFs for cervical spine diseases.