Complications After 3- and 4-Level Anterior Cervical Diskectomy and Fusion

Background: Anterior cervical diskectomy and fusion (ACDF) is a standard surgical procedure used widely in the treatment of degenerative cervical spine conditions. Although the safety and effectiveness of single-level ACDF is well supported in the literature, reports of multilevel ACDF are sparse and present mixed results. There is concern for greater complications with increasing levels of fusion given the increased complexity, procedure duration, and invasiveness of multilevel ACDF. Methods: In this retrospective review, we report complications data for 105 adult neurosurgical patients who underwent elective multilevel ACDF at a single institution by a single surgeon between 2004 and 2016. Results: Fifty-four patients underwent 3-level ACDF and 51 patients underwent 4-level ACDF with a mean follow-up of 2.7 ± 1.9 years. Although patients with 4-level fusion were more likely than those with 3-level fusion to have estimated blood loss ≥100 mL (P = 0.04), we found no significant differences in other peri- and postoperative complications, need for revision, and presence of symptoms at the time of last follow-up between groups. Conclusions: This study suggests that 4-level ACDF is not necessarily associated with a greater number of or more severe complications than 3-level ACDF.