Early Outcomes of Multilevel ACDF With Segmental Plate Fixation

Area of Science:

• Spine surgery outcomes
• Anterior cervical discectomy and fusion (ACDF)
• Orthopedic biomechanics

Background:

• Multilevel ACDF with single plates has high rates of pseudoarthrosis, dysphagia, and mechanical failure.
• Segmental ACDF using low-profile plates aims to simplify fixation and avoid limitations of integrated implants.

Purpose of the Study:

• To evaluate the outcomes of segmental plate fixation in multilevel ACDF.
• To assess fusion rates, subsidence, and clinical improvements following segmental ACDF.

Main Methods:

• Retrospective review of prospectively collected data from consecutive patients undergoing multilevel segmental ACDF.
• One-year follow-up assessing fusion via bridging bone and interspinous movement (ISM).
• Subsidence evaluated by segmental height change; CT scans used for fusion confirmation.

Main Results:

• Significant improvements in pain and disability (NDI) observed postoperatively.
• High fusion rates (94.6% bony bridging, 86.0% ISM <2 mm) achieved at one year.
• Subsidence occurred in 9.5% of levels, with no association between treated levels and pseudoarthrosis or subsidence.

Conclusions:

• Segmental plating in multilevel ACDF is safe, improving disability, pain, and alignment.
• Fusion rates are favorable compared to traditional plating, with alignment and subsidence similar to traditional ACDF.
• The number of treated levels did not impact pseudoarthrosis or subsidence rates.