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

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