Surgical Risk and Patient-Reported Outcomes in 3- and 4-Level Anterior Cervical Discectomy and Fusion: A Comparative...

Area of Science:

• Spine Surgery
• Orthopedics
• Neurosurgery

Background:

• Limited data compares outcomes of 3- versus 4-level standalone anterior cervical diskectomy and fusion (ACDF).
• Existing literature primarily focuses on 1- and 2-level ACDF procedures.

Purpose of the Study:

• To compare surgical outcomes and patient-reported outcome measures (PROMs) between 3-level and 4-level standalone ACDF.
• To evaluate the safety and efficacy of extended multi-level ACDF.

Main Methods:

• Retrospective review of patients undergoing 3- or 4-level ACDF (2014-2020).
• Evaluation of surgical outcomes and PROMs including neck/arm pain, SF-12, mJOA, and NDI.
• Exclusion criteria: incomplete data, non-degenerative etiologies, or concomitant posterior fusion.

Main Results:

• 4-level ACDF patients had higher BMI and myelopathy prevalence.
• Higher rates of dysphagia and 30-day ED visits observed in the 4-level ACDF group.
• Similar readmission rates and overall surgical outcomes; comparable PROM improvements except for 6-month NDI and 1-year mJOA.

Conclusions:

• 4-level ACDF is associated with increased BMI, myelopathy, dysphagia, and early ED utilization compared to 3-level ACDF.
• Extending fusion from three to four levels did not increase surgical risk or lead to inferior short-term functional or pain outcomes.
• Multi-level ACDF can be performed with comparable safety and functional results to shorter fusions.