Three-Level Anterior Cervical Discectomy and Fusion With or Without an Investigational Posterior Stabilization System...

Area of Science:

• Spine surgery
• Orthopedics
• Neurosurgery

Background:

• Anterior cervical discectomy and fusion (ACDF) is standard for cervical disc disease.
• Long-segment ACDF (3+ levels) risks non-union and complications.
• Circumferential cervical fusion (CCF) offers stability but increases surgical burden.

Purpose of the Study:

• Evaluate safety and effectiveness of ACDF vs. CCF for 3-level cervical disc disease.
• Assess outcomes using an investigational posterior cervical stabilization system (PCSS).

Main Methods:

• Prospective randomized controlled trial comparing ACDF and CCF (ACDF + posterior cervical fusion with PCSS).
• Primary endpoint: 12-month fusion success (bridging bone, range of motion <2°).
• Secondary endpoint: 24-month composite outcomes including fusion, NDI, neurological status, and revision rates.

Main Results:

• CCF showed higher 12-month fusion success (61%) than ACDF (17%) (P<0.001).
• 24-month outcomes favored CCF (51% vs. 23%) (P=0.002), with lower revision rates (2% vs. 23%) (P<0.001).
• Adverse event rates were similar between groups (ACDF 65%, CCF 46%).

Conclusions:

• This RCT is the first to assess 3-level cervical disc disease treatments.
• Long-segment ACDF has low fusion rates and high revision needs.
• Supplemental posterior cervical fusion with PCSS improves fusion without added complications.