Early Morbidity of Multilevel Anterior Cervical Discectomy and Fusion with Plating for Spondylosis: Does the Number of Levels Influence Early Complications? A Single Surgeon's Experience in 519 Consecutive Patients

Abstract

Study Design This is a retrospective review of a prospectively maintained database of anterior cervical discectomy and fusion with plating (ACDFP) cases.

Objective The aim of this study is to evaluate within a clinical practice evidence-based results of short-term morbidity with multilevel ACDFP.

Methods Clinical morbidity, length of hospital stay, visual analog scale (VAS) and Odom scores, Neck Disability Index (NDI), hardware failure, and return-to-work (RTW) status were prospectively collected in an electronic database for 678 patients who underwent 1-, 2-, 3-, or 4-level ACDFP during an 8-year period. A total of 519 patients met the study criteria and were retrospectively analyzed.

Results The majority of all patients noted “Excellent” or “Good” status for 1 month (91%), 2 months (92%), and 3 months (96%). Patients with 1-, 2-, and 3-level ACDFP returned to work sooner, 60% at 1 month, 70% at 2 months, and 68% at 3 months. For 4-level patients, the majority did not RTW until 3 months (71%). The only significant increase in morbidity with increasing levels was hospital stay for 3- and 4-level ACDFP and RTW for 4-level ACDFP.

Conclusion Multilevel ACDFP can be performed with low initial morbidity. An individual practice can review results to allow for ongoing evidence-based care.

Final class of evidence - treatment	Yes
Study design
RCT
Cohort	•
Case control
Case series
Methods
Concealed allocation (RCT)
Intention to treat (RCT)
Blinded/independent evaluation of primary outcome	•
F/U ≥ 85%
Adequate sample size	•
Control for confounding
Overall class of evidence	III

Keywords

ACDFP - cervical spine - morbidity

Previous Presentations of Paper

A portion of this work was presented as an electronic poster at the 2010 American Association of Neurological Surgeons meeting in Philadelphia, PA, and as an invited talk at the North Carolina Spine Society meeting in Charlotte, North Carolina, August 27 to 28, 2010.

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