Three-Level Anterior Cervical Discectomy and Fusion with Plate Fixation: Radiographic Results of 127 Patients

Abstract

Study Design. A retrospective radiographic review of all patients treated by a single surgeon with a three-level anterior cervical discectomy and fusion with plate fixation. Objectives. To compare fusion success rates and pseudoarthrosis results with published data for three-level anterior cervical constructs including; anterior cervical discectomy and fusion with plating (ACDFP) and anterior cervical corpectomy with and without plating (ACCP, ACC). Methods. In this study, authors have reviewed a series of 1416 patients done by a single surgeon between May 2001 and February 2008. Of these, 127 patients met standard criteria including a minimum of six months follow up, no previous cervical surgeries, and flexion/extension lateral radiographs. Pseudoarthrosis was defined as abnormal movement between the spinous processes, lucency at the graft vertebral body interface or absence of trabecular bone spanning the complete fused space. Fusion was identified by the absence of abnormal motion of the fused segments on flexion/extension lateral radiographs and the presence of continuous trabecular bone formation at the graft/endplate junction. Results. Of the 127 patients, 124 had successful fusions and 3 had pseudoarthrosis. Three hundred seventy-six out of three-hundred eighty-one (98.7%) levels fused while only five (1.3%) levels developed pseudoarthrosis. Conclusions. This study presents the largest reported series of patients undergoing a three-level ACDFP by a single surgeon with close follow up, and suggests that three-level ACDFP utilizing a standardized modified Smith-Robinson technique has an acceptably high level of fusion in comparison to other modalities.