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01-11-2018 | Original Article

Multi- versus single-level anterior cervical discectomy and fusion: comparing sagittal alignment, early adjacent segment degeneration, and clinical outcomes

Authors: Bryce A. Basques, Philip K. Louie, Jeremy Mormol, Jannat M. Khan, Kamran Movassaghi, Justin C. Paul, Arya Varthi, Edward J. Goldberg, Howard S. An

Published in: European Spine Journal | Issue 11/2018

Abstract

Purpose

The purpose of this study was to compare the rates of adjacent segment degeneration (ASD), sagittal alignment parameters, and patient-reported outcomes in patients who underwent multi-level versus single-level anterior cervical discectomy and fusion (ACDF).

Methods

A retrospective cohort analysis was performed on consecutive patients who underwent an ACDF. Pre- and post-operative radiographic assessment included ASD, change in C2–C7 lordosis, T1 angle, levels fused, sagittal vertical axis (SVA), fusion mass lordosis, proximal and distal adjacent segment lordosis. Patient-reported outcomes were obtained.

Results

Of the 404 that underwent an ACDF with a minimum of 6 months of follow-up (average 28 months), there was no significant difference in the rate of radiographic ASD overall (p = 0.479) or in the proximal or distal adjacent segments on multivariate analysis. Secondarily, the multi-level fusions appear to restore significantly greater amounts of lordosis compared to single-level procedures (p < 0.001) and are able to maintain the corrected cervical lordosis and fusion segment lordosis over time. From the immediate post-operative period to final follow-up, the single-level ACDFs show continuing lordosis improvement (p = 0.005) that is significantly greater than that of the multi-level constructs. There were no significant differences between pre-operative, post-operative, or change in patient-reported outcomes.

Conclusions

Two years following an ACDF, patients who underwent multi-level fusions appear to restore significantly greater amounts of lordosis compared to single-level procedures, while single-level ACDFs show significantly greater amounts of lordosis improvement over time. Multi-level procedures may not be at a significantly greater risk of developing early radiographic evidence of ASD compared to single-level procedure.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Available only for authorised users

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Title: Multi- versus single-level anterior cervical discectomy and fusion: comparing sagittal alignment, early adjacent segment degeneration, and clinical outcomes
Authors: Bryce A. Basques
Philip K. Louie
Jeremy Mormol
Jannat M. Khan
Kamran Movassaghi
Justin C. Paul
Arya Varthi
Edward J. Goldberg
Howard S. An
Publication date: 01-11-2018
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 11/2018
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-018-5677-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Multi- versus single-level anterior cervical discectomy and fusion: comparing sagittal alignment, early adjacent segment degeneration, and clinical outcomes

Abstract

Purpose

Methods

Results

Conclusions

Graphical abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Graphical abstract

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