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Clinical Outcomes After Four-Level Anterior Cervical Discectomy and Fusion

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: Anterior cervical discectomy and fusion (ACDF) demonstrates reliable improvement in neurologic symptoms associated with anterior compression of the cervical spine. There is a paucity of data on outcomes following 4-level ACDFs. The purpose of thi...

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Detalles Bibliográficos
Autores principales: Kreitz, Tyler M., Hollern, Douglas A., Padegimas, Eric M., Schroeder, Gregory D., Kepler, Christopher K., Vaccaro, Alexander R., Hilibrand, Alan S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6293423/
https://www.ncbi.nlm.nih.gov/pubmed/30560028
http://dx.doi.org/10.1177/2192568218770763
Descripción
Sumario:STUDY DESIGN: Retrospective cohort study. OBJECTIVES: Anterior cervical discectomy and fusion (ACDF) demonstrates reliable improvement in neurologic symptoms associated with anterior compression of the cervical spine. There is a paucity of data on outcomes following 4-level ACDFs. The purpose of this study was to evaluate clinical outcomes for patients undergoing 4-level ACDF. METHODS: All 4-level ACDFs with at least 1-year clinical follow-up were identified. Clinical outcomes, including fusion rates, neurologic outcomes, and reoperation rates were determined. RESULTS: Retrospective review of our institutional database revealed 25 patients who underwent 4-level ACDF with at least 1-year clinical follow-up. Average age was 57.5 years (range 38.2-75.0 years); 14 (56%) were male, and average body mass index was 30.2 kg/m(2) (range 19.9-43.4 kg/m(2)). Two (8%) required secondary cervical surgery at an average of 94.5 days postoperatively while the remaining 23 did not with an average follow-up of 19 months. Of 23 patients not requiring revision surgery, 16 (69%) patients fused by definition of less than 1 mm of spinous process motion per fused level in flexion and extension. Fifteen (65%) had at least one muscle group with one grade of weakness preoperatively. Nineteen of these patients (83%) had improved to full strength while no patients lost muscle strength. CONCLUSIONS: Review of our institution’s experience demonstrated a low rate of revision cervical surgery for any reason of 8% at mean 19 months follow-up, and neurological examinations consistently improved, despite a high rate of radiographic nonunion (31%).