Comparison Between Three- and Four-Level Anterior Cervical Discectomy and Fusion: Patient-Reported and Radiographic Outcomes.

Abstract Study Design Retrospective Cohort Study Objective To compare long-term clinical and radiographic outcomes following 3- and 4-level anterior cervical discectomy and fusion (ACDF). Methods Patients who underwent primary 3- or 4- level ACDF were retrospectively identified. Demographic data and patient-reported outcome measures (PROMs) were collected through chart review. PROM surveys were administered preoperatively as baseline measurements and at one-year postoperatively. Outcomes included the Neck Disability Index (NDI), Short-Form 12 Physical (PCS-12) and Mental (MCS-12) Components, and Visual Analog Scale (VAS) Neck and Arm pain scores. Cervical sagittal alignment parameters included C2-C7 Lordosis, Segmental Lordosis, Sagittal Vertical Axis, and T1 Slope. Multivariate regression models were used to compare changes in PROMs and radiographic measurements over time between 3- and 4-level ACDF. Correlation coefficients were calculated to compare delta scores of PROMs and radiographic measurements. Results VAS Neck and Arm scores significantly improved from baseline in both cohorts. Only the 3-level group showed significant improvements perioperatively for NDI and PCS-12. No significant differences were found in improvement of clinical outcomes between groups. Pooled results demonstrated a significant negative correlation between perioperative change in segmental lordosis and VAS Arm scores. A significant negative correlation was also seen between perioperative change in SVA and MCS-12 and VAS Neck scores. C2-C7 lordosis significantly increased postoperatively in only the 3-level ACDF group. Conclusions Patients undergoing both 3- and 4-level ACDF experienced significant clinical improvements without significant differences between groups. Radiographic measures of segmental lordosis and SVA were also found to correlate with changes in clinical outcomes.