Long-term Outcomes and Complications of Multilevel ACDF, Compared with Single-level ACDF, A Retrospective Study

Anusorn Kuruvanich; Ekkapot Jitpun; Teera Tangviriyapaiboon

Authors

Anusorn Kuruvanich Division of Neurosurgery, Neurological Institute of Thailand, Department of Medical Service, Ministry of Public Health
Ekkapot Jitpun Division of Neurosurgery, Neurological Institute of Thailand, Department of Medical Service, Ministry of Public Health
Teera Tangviriyapaiboon Division of Neurosurgery, Neurological Institute of Thailand, Department of Medical Service, Ministry of Public Health

Keywords:

ACDF, multilevel ACDF, single-level ACDF, anterior cervical discectomy and fusion, Long-term outcomes, complications

Abstract

Objective: To compare the clinical outcomes, radiological parameters, and complication incidence of patients who underwent anterior cervical discectomy and fusion (ACDF) to prove our hypothesis that multilevel ACDF did not have higher rate of complication than single level or 2-level ACDF.
Methods: We conducted a retrospective review of 82 consecutive patients who underwent ACDF for treatment of cervical spondylosis at Neurological Institute of Thailand in 10 years (2006 – 2015) by single surgeon. Patients were divided into 3 group (1-level, 2-level and 3 or 4 level ACDF). The clinical courses, fusion rate, postoperative complications, and radiographical adjacent-level changes regarding each group were evaluated.
Results: There is no statistical difference in restoration of cervical lordosis, and incidence of postoperative early and late complications between 1-level ACDF, 2-level ACDF and 3 or 4-level ACDF groups (P > 0.05). The 3 or 4-level ACDF group had more bleeding (P = 0.000) and longer length of stay in hospital (p = 0.002), with no clinically significant. Subgroup analysis of 3-level ACDF and 4-level ACDF had no statistical differences in all categories.
Conclusion: This study showed that result of multilevel ACDF was not different from 1 or 2-level ACDF in all outcome parameters. Compared to previous systematic review of posterior approach, this study does not show different results and complications. Multilevel ACDF had no higher risk of surgery in comparison to 1 or 2-level ACDF.

Downloads

Download data is not yet available.

References

Lawrence BD, Jacobs WB, Norvell DC, Hermsmeyer JT, Chapman JR, Brodke DS. Anterior versus posterior approach for treatment of cervical spondylotic myelopathy. Spine (Phila Pa 1976). 2013;38(22 Suppl 1):S173-82.

Emery SE. Cervical spondylotic myelopathy: diagnosis and treatment. J Am Acad Orthop Surg. 2001;9(6):376-88.

Smith GW, Robinson RA. The treatment of certain cervical spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am. 1958;40(3):607-24.

De la Garza-Ramos R, Xu R, Ramhmdani S, et al. Long-term clinical outcomes following 3- and 4-level anterior cervical discectomy and fusion. J Neurosurg Spine. 2016;24(6):885-91.

Chin KR, Eiszner JR, Adams SB. Less exposure surgery for multilevel anterior cervical fusion using 2 transverse incisions. J Neurosurg Spine. 2012;17(3):194-8.

Cunningham MR, Hershman S, Bendo JA. Systematic review of cohort studies comparing surgical treatments for cervical spondylotic myelopathy. Spine (Phila Pa 1976). 2010;35(5):537-43.

Liu Y, Hou Y, Yang L, Chen H, Wang X, Wu X. Comparison of 3 reconstructive techniques in the surgical management of multilevel cervical spondylotic myelopathy. Spine (Phila Pa 1976). 2012;37(23):E1450-8.

Kilburg C, Sullivan HG, Mathiason MA. Effect of approach side during anterior cervical discectomy and fusion on the incidence of recurrent laryngeal nerve injury. J Neurosurg Spine. 2006;4(4):273-7.

Furlan JC, Kalsi-Ryan S, Kailaya-Vasan A, Massicotte EM, Fehlings MG. Functional and clinical outcomes following surgical treatment in patients with cervical spondylotic myelopathy: a prospective study of 81 cases. J Neurosurg Spine. 2011;14(3):348-55.