Clinical Outcomes After 4- and 5-Level Anterior Cervical Discectomy and Fusion for Treatment of Symptomatic Multilevel Cervical Spondylosis

World Neurosurg. 2022 Jul:163:e363-e376. doi: 10.1016/j.wneu.2022.03.119. Epub 2022 Apr 1.


Objective: There are limited patient-reported outcome measure (PROM) data on 4-level and 5-level anterior cervical discectomy and fusion (ACDF). The largest series to date solely focused on complications. This retrospective series evaluates PROMs after 4-level and 5-level ACDF.

Methods: Pertinent data from adult patients treated with a 4-level or 5-level ACDF in 2011-2019 were analyzed. PROMs and minimal clinically important differences (MCIDs) were assessed. Factors associated with favorable and unfavorable outcomes were identified.

Results: There were 34 patients (30 underwent 4-level and 4 underwent 5-level ACDFs) with a mean age of 59.6 years; 55.9% were women. At 3 months, there were significant improvements in PROMs except Short-Form 12-Item Survey (SF-12) mental component subscale, which showed modest improvement. At 12 months, there were significant improvements in PROMs except SF-12 physical component subscale (PCS), which showed moderate improvement. The proportions of patients who met the MCID cutoffs ranged from 35.3% (numeric rating scale [NRS]-neck) to 75% (Veteran RAND 12-Item Survey [VR-12] PCS) at 3 months and 38.2% (NRS-arm) to 65.5% (VR-12 mental component subscale) at 12 months. Shorter symptom duration was associated with significantly reduced postoperative pain and Neck Disability Index scores. Shorter length of stay was associated with significantly improved postoperative functional outcomes. patients undergoing 4-level compared with 5-level ACDF achieved better postoperative PROMs. Shorter procedure duration was associated with improved PROMs at 3 months. No patient returned to the operating room within 30 days. Patients who required reoperation achieved significantly inferior Neck Disability Index, NRS-neck, and SF-12 PCS scores at 3 months.

Conclusions: This study showed satisfactory PROMs up to 12 months after 4-level and 5-level ACDF despite the complication rate. With thorough preoperative planning and meticulous technique, performing this procedure in carefully selected patients may be associated with acceptable PROMs.

Keywords: 4- and 5-level ACDF; Anterior cervical discectomy and fusion; Cervical spondylosis; Minimal clinically important difference; Patient-reported outcome measures.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cervical Vertebrae* / surgery
  • Diskectomy* / methods
  • Female
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Spinal Fusion* / methods
  • Spondylosis* / surgery
  • Treatment Outcome