Three-Level Anterior Cervical Discectomy and Fusion With Plate Fixation

In Brief Study Design. Retrospective review of patients with cervical spondylosis treated with 3-level anterior cervical discectomy and fusion with plate fixation. Objective. To assess the radiographic and clinical outcome of 3-level instrumented anterior cervical discectomy. Summary of Background Data. Three-level cervical discectomy without plate fixation has shown high rates of pseudarthrosis and poor outcomes. The addition of internal fixation may improve these parameters. Methods. A total of 46 patients were observed for an average of 17.6 months (range, 6–51 months). All had 3-level anterior cervical discectomy and fusion with tricortical iliac crest autograft (4 cases), fibular ring allograft (38 cases), or titanium cage (4 cases). Allografts and cages were filled with iliac crest autograft. All patients had semirigid plating. Clinical and radiographic follow-up data were obtained. Clinical outcomes were measured as described by Robinson and with the Nurick scale. Results. Forty-four patients achieved solid fusion. Two patients had additional surgery for junctional disease, and in 1 of them pseudarthrosis repair was also performed. One asymptomatic pseudarthrosis was noted. With a successful result defined as an excellent or good outcome accompanied by significant pain relief, 38 patients had a successful result (83%). Radiographic adjacent level disease was diagnosed in 11 patients after surgery and was symptomatic in 5. Conclusion. Three-level anterior cervical discectomy with plate fixation has a high rate of fusion, a low complication rate, and acceptable outcome in the treatment of multilevel cervical spondylosis. Forty-six patients with cervical spondylosis that underwent 3-level anterior cervical discectomy and instrumented fusion are presented. Two patients required additional surgery for junctional disease; 1 of them underwent simultaneous pseudarthrosis repair. One asymptomatic pseudarthrosis was noted. Outcomes were good or excellent in 83% of patients.