Outcomes and revision rates following multilevel anterior cervical discectomy and fusion

Laratta, Joseph L.; Reddy, Hemant; Bratcher, Kelly R.; McGraw, Katlyn E.; Carreon, Leah Y.; Owens, R. Kirk

doi:10.21037/jss.2018.06.16

Cited by 48 publications

(51 citation statements)

References 13 publications

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“…It is routinely performed for one-and two-level cervical disc disease in patients presenting with cervical radicular symptoms or myelopathy. Surgical outcomes and symptom resolution are typically acceptable in patients undergoing one-and two-level ACDF [3]. For patients presenting with multi-level cervical disc disease, a three-to four-level ACDF may be necessary to address all levels involved.…”

mentioning

confidence: 99%

Kyphosis Correction in Patients Undergoing a Four-Level Anterior Cervical Discectomy and Fusion

Ebot

Foskey

Domingo

et al. 2020

Cureus

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Introduction Cervical kyphotic deformity can be quite debilitating. Most patients present with neck pain, but they can also present with radiculopathy, myelopathy, altered vertical gaze, swallowing problems, and even cosmetic issues from the severe kyphotic deformity. After failing conservative management, surgery remains the only option for halting symptom progression. Surgical options for cervical kyphosis have included anterior-only approaches, posterior-only approaches, or 360-and 540-degree reconstructions. This paper addresses the correction of cervical kyphotic deformity via an anterior-only approach consisting of a four-level anterior cervical discectomy and fusion (ACDF). Methods We interrogated our procedure log system and the keyword "anterior cervical discectomy and fusion (ACDF)" was typed into the search bar. All patients with an ACDF for the past five years were reviewed and patients with a four-level ACDF were selected. Chart review was performed and patients presenting with multi-level cervical stenosis with kyphosis were included in the study. Pre-and post-surgery images were reviewed, and the degrees of pre-operative kyphosis and post-operative lordosis were measured. Results Our search produced 20 patients. All the patients had a diagnosis of multi-level cervical stenosis with or without myelopathy and were all symptomatic. Pre-operative kyphosis ranged from 2.3 to 35 (mean 11.5) degrees, and post-operative lordosis ranged from 2 to 38 (mean 16) degrees. All the patients had varying degrees of kyphosis correction post-surgery which ranged from 6 to 44 (mean 27) degrees. Significant improvement or complete resolution of symptoms post-operatively occurred in all patients. Conclusion Four-level ACDF in carefully selected patients can be used to correct cervical alignment in patients presenting with symptomatic multi-level cervical stenosis with kyphosis.

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confidence: 99%

Kyphosis Correction in Patients Undergoing a Four-Level Anterior Cervical Discectomy and Fusion

Ebot

Foskey

Domingo

et al. 2020

Cureus

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“…In a recently published study, reductions of 26.1% in NDI, 33.4% in neck pain, and 50.4% in arm pain were reported for multilevel ACDF at 24 months. 38 However, multilevel ACDF may cause even greater stresses to adjacent discs, and, compared with single-level ACDF, multilevel ACDF yields higher rates of pseudarthrosis, complications, revisions, and reoperations. The 24month reoperation rate has been reported elsewhere to be 35% for patients who underwent 3-and 4-level cervical fusion.…”

Section: Discussionmentioning

confidence: 99%

“…The 24month reoperation rate has been reported elsewhere to be 35% for patients who underwent 3-and 4-level cervical fusion. 38 In an effort to preserve segmental motion, both multilevel CDA and a hybrid surgical treatment combining CDA and ACDF have been considered. However, the preference of either of these motion-sparing treatments is dependent on the severity of disc degeneration and optimized patient selection.…”

Section: Discussionmentioning

confidence: 99%

Multilevel Cervical Disc Arthroplasty: Long-Term Outcomes at 3 and 4 Levels

et al. 2020

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Background: Multilevel cervical degenerative disc disease in 2 or more segments poses treatment challenges. Anterior cervical discectomy and fusion is a viable treatment option, but one with high rates of adjacent segment disease and pseudoarthrosis. Cervical disc arthroplasty (CDA) is approved by the US Food and Drug Administration for the treatment of 1-and 2-level cervical pathology, with established long-term safety and effectiveness. Limited evidence exists for CDA at more than 2 levels. This study investigates the long-term outcomes of 3-and 4-level CDA out to 7 years. Methods: In a retrospective review of prospectively collected data, patient demographics and surgical characteristics were collected. Patient-reported outcomes (PROs) were collected preoperatively and at 6 weeks, 3 months, 6 months, and 12 months postoperatively, and annually thereafter, including: Neck Disability Index (NDI), numeric rating scales for neck pain and arm pain, the Veterans Rand 12-item Health Survey physical component summary (PCS) score and mental component summary (MCS) score, and patient satisfaction scores. Secondary surgery data were also collected. Predictive methods using mixed-effects regression models were used to analyze the data. Results: Data for 139 CDAs were available for evaluation (n ¼ 116 three-level and n ¼ 23 four-level). Statistical improvement was shown for all PRO scores at all postoperative intervals (P , .001). From preoperatively to 7 years postoperatively, mean NDI decreased from 57.9 to 31.3 (45.9% improvement), mean neck pain decreased from 15.6 to 7.9 (49.4% improvement), mean arm pain decreased from 12.2 to 5.6 (54.1% improvement), mean PCS increased from 29.2 to 41.4 (41.8% improvement), and mean MCS increased from 37.1 to 44.5 (19.9% improvement). Five (3.6%) 3level patients underwent secondary surgery. Patient satisfaction exceeded 88% 7 years after surgery. Conclusion: Statistical improvement in PROs, with a low rate of secondary surgeries out to 7 years, demonstrates that 3-and 4-level CDA may be performed safely and effectively in appropriately selected patients. Level of Evidence: 4.

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“…It is observed that the definition of pseudoarthrosis varied significantly within the literature [22,23,24]. We stratified our patients with IF grade III for possible risk factors and could not identify any predisposing risk factors in our study (Table S2) [25,26,27].…”

Section: Discussionmentioning

confidence: 99%

First Clinical Experience with a Carbon Fibre Reinforced PEEK Composite Plating System for Anterior Cervical Discectomy and Fusion

Milavec

Kellner

Ravikumar

et al. 2019

JFB

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Carbon fibre reinforced polyether ether ketone (CFR-PEEK) is a suitable material to replace metal implants in orthopaedic surgery. The radiolucency of CFR-PEEK allows an optimal visualisation of the bone and soft tissue structures. We aimed to assess the performance and radiological and clinical outcomes of anterior cervical discectomy and fusion (ACDF) with CFR-PEEK anterior cervical plating (ACP) under first use clinical conditions. We retrospectively studied the prospectively-collected data of 42 patients who underwent ACDF with CFR-PEEK ACP between 2011 and 2016. We assessed clinical outcome (Odom’s criteria, complications) and radiological parameters (global and segmental cervical lordosis, Bridwell score for fusion, adjacent segment degeneration) preoperatively, immediately post-operatively, and after a 12-month follow-up period. Patients’ satisfaction was excellent, good, fair, and poor in 12, 19, 3, and 1 patients, respectively. Two patients developed dysphagia. No hardware failure occurred. Compared with preoperative radiographs, we observed a gain of global cervical lordosis and segmental lordosis (7.4 ± 10.1 and 5.6 ± 7.1 degrees, respectively) at the 12-month follow-up. Bridwell IF grades I, II, and III were observed in 22, 6, and 7 patients, respectively. The 12-month adjacent segment degeneration-free and adjacent segment disease-free survival rates were 93.1% and 96.3%, respectively. We observed a dysphagia rate of 5.7% and a reoperation rate of 4.8%. In conclusion, CFR-PEEK ACP shows positive outcomes in terms of implant safety, restoration of cervical lordosis, and functional recovery, and is suitable for ACDF.

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Outcomes and revision rates following multilevel anterior cervical discectomy and fusion

Cited by 48 publications

References 13 publications

Kyphosis Correction in Patients Undergoing a Four-Level Anterior Cervical Discectomy and Fusion

Kyphosis Correction in Patients Undergoing a Four-Level Anterior Cervical Discectomy and Fusion

Multilevel Cervical Disc Arthroplasty: Long-Term Outcomes at 3 and 4 Levels

First Clinical Experience with a Carbon Fibre Reinforced PEEK Composite Plating System for Anterior Cervical Discectomy and Fusion

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