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

Publication ,  Journal Article
McClure, JJ; Desai, BD; Shabo, LM; Buell, TJ; Yen, C-P; Smith, JS; Shaffrey, CI; Shaffrey, ME; Buchholz, AL
Published in: J Neurosurg Spine
October 9, 2020

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.

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Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

October 9, 2020

Volume

34

Issue

1

Start / End Page

45 / 51

Location

United States

Related Subject Headings

  • Orthopedics
  • 3209 Neurosciences
  • 1109 Neurosciences
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
McClure, J. J., Desai, B. D., Shabo, L. M., Buell, T. J., Yen, C.-P., Smith, J. S., … Buchholz, A. L. (2020). A single-center retrospective analysis of 3- or 4-level anterior cervical discectomy and fusion: surgical outcomes in 66 patients. J Neurosurg Spine, 34(1), 45–51. https://doi.org/10.3171/2020.6.SPINE20171
McClure, Jesse J., Bhargav D. Desai, Leah M. Shabo, Thomas J. Buell, Chun-Po Yen, Justin S. Smith, Christopher I. Shaffrey, Mark E. Shaffrey, and Avery L. Buchholz. “A single-center retrospective analysis of 3- or 4-level anterior cervical discectomy and fusion: surgical outcomes in 66 patients.J Neurosurg Spine 34, no. 1 (October 9, 2020): 45–51. https://doi.org/10.3171/2020.6.SPINE20171.
McClure JJ, Desai BD, Shabo LM, Buell TJ, Yen C-P, Smith JS, et al. A single-center retrospective analysis of 3- or 4-level anterior cervical discectomy and fusion: surgical outcomes in 66 patients. J Neurosurg Spine. 2020 Oct 9;34(1):45–51.
McClure, Jesse J., et al. “A single-center retrospective analysis of 3- or 4-level anterior cervical discectomy and fusion: surgical outcomes in 66 patients.J Neurosurg Spine, vol. 34, no. 1, Oct. 2020, pp. 45–51. Pubmed, doi:10.3171/2020.6.SPINE20171.
McClure JJ, Desai BD, Shabo LM, Buell TJ, Yen C-P, Smith JS, Shaffrey CI, Shaffrey ME, Buchholz AL. A single-center retrospective analysis of 3- or 4-level anterior cervical discectomy and fusion: surgical outcomes in 66 patients. J Neurosurg Spine. 2020 Oct 9;34(1):45–51.

Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

October 9, 2020

Volume

34

Issue

1

Start / End Page

45 / 51

Location

United States

Related Subject Headings

  • Orthopedics
  • 3209 Neurosciences
  • 1109 Neurosciences
  • 1103 Clinical Sciences