gms | German Medical Science

Objective: Anterior cervical discectomy and fusion (ACDF) has become a standard procedure in the treatment of various cervical pathologies. Many centers combine ACDF with ventral plate implantation especially in multilevel surgery. The aim of this study is to determine the safety und utility of anterior cervical discectomy and fusion with intervertebral cage alone for 3 level surgery or more without implantation of a ventral plate or additional posterior stabilization.

Methods: A series of 26 patients underwent ACDF for three levels or more. Mean age at surgery was 67 years (range 44-80 years). Twenty-two patients underwent surgery for 3 levels, and 4 patients for 4 levels. Patient demographics, clinical, radiological and follow up data were reviewed and analyzed. For the last follow-up patients were contacted by telephone interview. Outcome was measured according to clinical visual analog pain scale (VAS), patient satisfaction index (MacNab's outcome score) and neck disability index (NDI).

Results: There were no intraoperative complications. One patient (4%) underwent revision surgery due to cage dislocation. No neurological deficits were observed in the perioperative period. All patients except 3 were available for follow-up. The mean follow-up time was 4.6 years. X-ray imaging studies 3 months after surgery showed stable fusion in all follow-up patients. The mean NDI improved from 28 to 24 at the last follow up. The patient satisfaction score yielded the following results: 12 excellent, 7 good, 3 fair and 4 poor outcomes.

Conclusion: Anterior cervical discectomy and fusion without instrumental stabilization for multilevel cervical disc degeneration represents a safe and effective procedure. Cage dislocation and non-fusion occurs rarely.