Comparing ACDF Outcomes by Cervical Spine Level: A Single Center Retrospective Cohort Study

Area of Science:

• Neurosurgery
• Spinal Surgery
• Orthopedics

Background:

• Limited research compares outcomes between upper cervical fusions (UCFs) and middle-to-lower cervical fusions (MLCFs).
• Previous studies suggest a link between anterior cervical discectomy and fusion complications and the specific cervical levels involved.

Purpose of the Study:

• To compare postoperative outcomes of upper cervical fusions (UCFs) with middle-to-lower cervical fusions (MLCFs).

Main Methods:

• Retrospective review of 835 anterior cervical discectomy and fusion patients (2012-2022).
• Patients classified as UCF (C3-C4 disc space included) or MLCF (C3-C4 disc space excluded).
• Statistical analysis included chi-squared tests, Fisher exact tests, and mixed-effects models to compare demographics and clinical characteristics.

Main Results:

• UCF patients had a significantly longer length of stay (2.3 vs 3.3 days) and higher rates of dysphagia (1.66 times higher).
• MLCF patients reported symptom improvement or resolution more frequently than UCF patients (0.46 vs 0.43).
• These differences persisted after controlling for pre- and intraoperative variables.

Conclusions:

• Upper cervical fusions are associated with worse postoperative outcomes, including increased dysphagia and longer hospital stays, compared to MLCFs.
• Findings suggest UCFs may lead to a lower likelihood of neurological symptom improvement.
• Results can inform surgical decision-making and patient counseling regarding cervical fusion levels.