Long-term clinical outcomes following 3- and 4-level anterior cervical discectomy and fusion

Rafael De la Garza-Ramos, Risheng Xu, Seba Ramhmdani, Thomas Kosztowski, Mohamad Bydon, Daniel M. Sciubba, Jean Paul Wolinsky, Timothy F. Witham, Ziya L. Gokaslan, Ali Bydon

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

OBJECTIVE The purpose of this study was to report the long-term clinical outcomes following 3- and 4-level anterior cervical discectomy and fusion (ACDF). METHODS A retrospective review of all adult neurosurgical patients undergoing elective ACDF for degenerative disease at a single institution between 1996 and 2013 was performed. Patients who underwent first-time 3- or 4-level ACDF were included; patients with previous cervical spine surgery, those undergoing anterior/posterior approaches, and those with corpectomy were excluded. Outcome measures included perioperative complication rates, fusion rates, need for revision surgery, Nurick Scores, Odom's criteria, symptom resolution, neck visual analog scale (VAS) pain score, and persistent narcotics usage. RESULTS Seventy-one patients who underwent 3-level ACDF and 26 patients who underwent 4-level ACDF were identified and followed for an average of 7.6 ± 4.2 years. There was 1 case (3.9%) of deep wound infection in the 4-level group and 1 case in the 3-level group (1.4%; p = 0.454). Postoperatively, 31% of patients in the 4-level group complained of dysphagia, compared with 12.7% in the 3-level group (p = 0.038). The fusion rate was 84.6% after 4-level ACDF and 94.4% after 3-level ACDF (p = 0.122). At last follow-up, a significantly higher proportion of patients in the 4-level group continued to have axial neck pain (53.8%) than in the 3-level group (31%; p = 0.039); the daily oral morphine equivalent dose was significantly higher in the 4-level group (143 ± 97 mg/day) than in the 3-level group (25 ± 10 mg/day; p = 0.030). Outcomes based on Odom's criteria were also different between cohorts (p = 0.044), with a significantly lower proportion of patients in the 4-level ACDF group experiencing an excellent/good outcome. CONCLUSIONS In this study, patients who underwent 4-level ACDF had significantly higher rates of dysphagia, postoperative neck pain, and postoperative narcotic usage when compared with patients who underwent 3-level ACDF. Pseudarthrosis and deep wound infection rates were also higher in the 4-level group, although this did not reach statistical significance. Additionally, a smaller proportion of patients achieved a good/excellent outcome in the 4-level group than in the 3-level group. These findings suggest a significant increase of perioperative morbidity and worsened outcomes for patients who undergo 4- versus 3-level ACDF.

Original languageEnglish (US)
Pages (from-to)885-891
Number of pages7
JournalJournal of neurosurgery. Spine
Volume24
Issue number6
DOIs
StatePublished - Jun 1 2016
Externally publishedYes

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Diskectomy
Neck Pain
Narcotics
Wound Infection
Deglutition Disorders
Pseudarthrosis
Pain Measurement
Postoperative Pain
Reoperation
Morphine
Spine
Neck

Keywords

  • 3-level
  • 4-level
  • ACDF
  • ACDF = anterior cervical discectomy and fusion
  • anterior cervical discectomy and fusion
  • ASD = adjacent-segment disease
  • cervical spine
  • fusion
  • outcomes

ASJC Scopus subject areas

  • Medicine(all)

Cite this

De la Garza-Ramos, R., Xu, R., Ramhmdani, S., Kosztowski, T., Bydon, M., Sciubba, D. M., ... Bydon, A. (2016). Long-term clinical outcomes following 3- and 4-level anterior cervical discectomy and fusion. Journal of neurosurgery. Spine, 24(6), 885-891. https://doi.org/10.3171/2015.10.SPINE15795

Long-term clinical outcomes following 3- and 4-level anterior cervical discectomy and fusion. / De la Garza-Ramos, Rafael; Xu, Risheng; Ramhmdani, Seba; Kosztowski, Thomas; Bydon, Mohamad; Sciubba, Daniel M.; Wolinsky, Jean Paul; Witham, Timothy F.; Gokaslan, Ziya L.; Bydon, Ali.

In: Journal of neurosurgery. Spine, Vol. 24, No. 6, 01.06.2016, p. 885-891.

Research output: Contribution to journalArticle

De la Garza-Ramos, R, Xu, R, Ramhmdani, S, Kosztowski, T, Bydon, M, Sciubba, DM, Wolinsky, JP, Witham, TF, Gokaslan, ZL & Bydon, A 2016, 'Long-term clinical outcomes following 3- and 4-level anterior cervical discectomy and fusion', Journal of neurosurgery. Spine, vol. 24, no. 6, pp. 885-891. https://doi.org/10.3171/2015.10.SPINE15795
De la Garza-Ramos R, Xu R, Ramhmdani S, Kosztowski T, Bydon M, Sciubba DM et al. Long-term clinical outcomes following 3- and 4-level anterior cervical discectomy and fusion. Journal of neurosurgery. Spine. 2016 Jun 1;24(6):885-891. https://doi.org/10.3171/2015.10.SPINE15795
De la Garza-Ramos, Rafael ; Xu, Risheng ; Ramhmdani, Seba ; Kosztowski, Thomas ; Bydon, Mohamad ; Sciubba, Daniel M. ; Wolinsky, Jean Paul ; Witham, Timothy F. ; Gokaslan, Ziya L. ; Bydon, Ali. / Long-term clinical outcomes following 3- and 4-level anterior cervical discectomy and fusion. In: Journal of neurosurgery. Spine. 2016 ; Vol. 24, No. 6. pp. 885-891.
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abstract = "OBJECTIVE The purpose of this study was to report the long-term clinical outcomes following 3- and 4-level anterior cervical discectomy and fusion (ACDF). METHODS A retrospective review of all adult neurosurgical patients undergoing elective ACDF for degenerative disease at a single institution between 1996 and 2013 was performed. Patients who underwent first-time 3- or 4-level ACDF were included; patients with previous cervical spine surgery, those undergoing anterior/posterior approaches, and those with corpectomy were excluded. Outcome measures included perioperative complication rates, fusion rates, need for revision surgery, Nurick Scores, Odom's criteria, symptom resolution, neck visual analog scale (VAS) pain score, and persistent narcotics usage. RESULTS Seventy-one patients who underwent 3-level ACDF and 26 patients who underwent 4-level ACDF were identified and followed for an average of 7.6 ± 4.2 years. There was 1 case (3.9{\%}) of deep wound infection in the 4-level group and 1 case in the 3-level group (1.4{\%}; p = 0.454). Postoperatively, 31{\%} of patients in the 4-level group complained of dysphagia, compared with 12.7{\%} in the 3-level group (p = 0.038). The fusion rate was 84.6{\%} after 4-level ACDF and 94.4{\%} after 3-level ACDF (p = 0.122). At last follow-up, a significantly higher proportion of patients in the 4-level group continued to have axial neck pain (53.8{\%}) than in the 3-level group (31{\%}; p = 0.039); the daily oral morphine equivalent dose was significantly higher in the 4-level group (143 ± 97 mg/day) than in the 3-level group (25 ± 10 mg/day; p = 0.030). Outcomes based on Odom's criteria were also different between cohorts (p = 0.044), with a significantly lower proportion of patients in the 4-level ACDF group experiencing an excellent/good outcome. CONCLUSIONS In this study, patients who underwent 4-level ACDF had significantly higher rates of dysphagia, postoperative neck pain, and postoperative narcotic usage when compared with patients who underwent 3-level ACDF. Pseudarthrosis and deep wound infection rates were also higher in the 4-level group, although this did not reach statistical significance. Additionally, a smaller proportion of patients achieved a good/excellent outcome in the 4-level group than in the 3-level group. These findings suggest a significant increase of perioperative morbidity and worsened outcomes for patients who undergo 4- versus 3-level ACDF.",
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T1 - Long-term clinical outcomes following 3- and 4-level anterior cervical discectomy and fusion

AU - De la Garza-Ramos, Rafael

AU - Xu, Risheng

AU - Ramhmdani, Seba

AU - Kosztowski, Thomas

AU - Bydon, Mohamad

AU - Sciubba, Daniel M.

AU - Wolinsky, Jean Paul

AU - Witham, Timothy F.

AU - Gokaslan, Ziya L.

AU - Bydon, Ali

PY - 2016/6/1

Y1 - 2016/6/1

N2 - OBJECTIVE The purpose of this study was to report the long-term clinical outcomes following 3- and 4-level anterior cervical discectomy and fusion (ACDF). METHODS A retrospective review of all adult neurosurgical patients undergoing elective ACDF for degenerative disease at a single institution between 1996 and 2013 was performed. Patients who underwent first-time 3- or 4-level ACDF were included; patients with previous cervical spine surgery, those undergoing anterior/posterior approaches, and those with corpectomy were excluded. Outcome measures included perioperative complication rates, fusion rates, need for revision surgery, Nurick Scores, Odom's criteria, symptom resolution, neck visual analog scale (VAS) pain score, and persistent narcotics usage. RESULTS Seventy-one patients who underwent 3-level ACDF and 26 patients who underwent 4-level ACDF were identified and followed for an average of 7.6 ± 4.2 years. There was 1 case (3.9%) of deep wound infection in the 4-level group and 1 case in the 3-level group (1.4%; p = 0.454). Postoperatively, 31% of patients in the 4-level group complained of dysphagia, compared with 12.7% in the 3-level group (p = 0.038). The fusion rate was 84.6% after 4-level ACDF and 94.4% after 3-level ACDF (p = 0.122). At last follow-up, a significantly higher proportion of patients in the 4-level group continued to have axial neck pain (53.8%) than in the 3-level group (31%; p = 0.039); the daily oral morphine equivalent dose was significantly higher in the 4-level group (143 ± 97 mg/day) than in the 3-level group (25 ± 10 mg/day; p = 0.030). Outcomes based on Odom's criteria were also different between cohorts (p = 0.044), with a significantly lower proportion of patients in the 4-level ACDF group experiencing an excellent/good outcome. CONCLUSIONS In this study, patients who underwent 4-level ACDF had significantly higher rates of dysphagia, postoperative neck pain, and postoperative narcotic usage when compared with patients who underwent 3-level ACDF. Pseudarthrosis and deep wound infection rates were also higher in the 4-level group, although this did not reach statistical significance. Additionally, a smaller proportion of patients achieved a good/excellent outcome in the 4-level group than in the 3-level group. These findings suggest a significant increase of perioperative morbidity and worsened outcomes for patients who undergo 4- versus 3-level ACDF.

AB - OBJECTIVE The purpose of this study was to report the long-term clinical outcomes following 3- and 4-level anterior cervical discectomy and fusion (ACDF). METHODS A retrospective review of all adult neurosurgical patients undergoing elective ACDF for degenerative disease at a single institution between 1996 and 2013 was performed. Patients who underwent first-time 3- or 4-level ACDF were included; patients with previous cervical spine surgery, those undergoing anterior/posterior approaches, and those with corpectomy were excluded. Outcome measures included perioperative complication rates, fusion rates, need for revision surgery, Nurick Scores, Odom's criteria, symptom resolution, neck visual analog scale (VAS) pain score, and persistent narcotics usage. RESULTS Seventy-one patients who underwent 3-level ACDF and 26 patients who underwent 4-level ACDF were identified and followed for an average of 7.6 ± 4.2 years. There was 1 case (3.9%) of deep wound infection in the 4-level group and 1 case in the 3-level group (1.4%; p = 0.454). Postoperatively, 31% of patients in the 4-level group complained of dysphagia, compared with 12.7% in the 3-level group (p = 0.038). The fusion rate was 84.6% after 4-level ACDF and 94.4% after 3-level ACDF (p = 0.122). At last follow-up, a significantly higher proportion of patients in the 4-level group continued to have axial neck pain (53.8%) than in the 3-level group (31%; p = 0.039); the daily oral morphine equivalent dose was significantly higher in the 4-level group (143 ± 97 mg/day) than in the 3-level group (25 ± 10 mg/day; p = 0.030). Outcomes based on Odom's criteria were also different between cohorts (p = 0.044), with a significantly lower proportion of patients in the 4-level ACDF group experiencing an excellent/good outcome. CONCLUSIONS In this study, patients who underwent 4-level ACDF had significantly higher rates of dysphagia, postoperative neck pain, and postoperative narcotic usage when compared with patients who underwent 3-level ACDF. Pseudarthrosis and deep wound infection rates were also higher in the 4-level group, although this did not reach statistical significance. Additionally, a smaller proportion of patients achieved a good/excellent outcome in the 4-level group than in the 3-level group. These findings suggest a significant increase of perioperative morbidity and worsened outcomes for patients who undergo 4- versus 3-level ACDF.

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KW - 4-level

KW - ACDF

KW - ACDF = anterior cervical discectomy and fusion

KW - anterior cervical discectomy and fusion

KW - ASD = adjacent-segment disease

KW - cervical spine

KW - fusion

KW - outcomes

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