Abstract
Introduction
Concerns remains on the role of ACDF in multilevel cervical disease as opposite to posterior approaches, and on the importance of cervical sagittal alignment in influencing long-term clinical outcome. We aim to analyze the efficacy of 3- and 4-level ACDF with a zero-profile implant in restoring cervical sagittal alignemnt as well as the impact of alignment on clinical outcome, both at early and long-term follow-up. And also to evaluate type and rate of complications.
Material and Methods
24 patients (14 male), ranging in age from 41 to 77 years (mean 58.4) and suffering from multilevel spondylosis, were enrolled. Neurological improvement was graded according to the Nurick scale. NDI, VAS and SF-36 were used for pre- and postoperative functional evaluation. Imaging included X-rays, CT and MRI before surgery; X-rays were obtained at every follow-up visit and CT scan at last follow-up. Sagittal alignment was assessed before and after surgery using the Cobb method. Fusion rate was studied on both X-rays and CT scan. Complications were analyzed and dysphagia evaluated using the Bazaz scale.
Results
Mean follow-up ranges from 24 to 72 months (mean 39). No intra- or postoperative complications, either related to surgical technique or to devices implanted, were encountered. Mean neck pain VAS score decreased from a 6.7 ± 2.9 to 1.6 ± 2.3 (p < 0.01). Mean arm pain VAS score decreased from 5.9 ± 2.9 to 0.9 ± 1.4 (p < 0.01). There were significant improvements (p < 0.01) in SF36 and NDI following surgery. Five patients complained of mild dysphagia (20.8%). Three of them (12.5%) showed complete resolution within two months (short-term dysphagia); the other two (8.3%) within six months (medium-term dysphagia). No case of long-term dysphagia (more than 6 months) was observed. According to Pitzen criteria, radiographic fusion was achieved in 90% of patients. Cobb angle had a significant improvement both after surgery and at long-term follow-up.
Conclusion
3- and 4-level ACDF with a zero-profile device is safe and effective. It allows satisfactory neurological and functional outcome as well as interbody fusion. Multilevel anterior approach provides satisfactory sagittal alignment restoration, and this is associated with persistent clinical improvement at long-term follow-up.