3-LEVEL ANTERIOR CERVICAL DISKECTOMY AND FUSION - RADIOGRAPHIC AND CLINICAL-RESULTS

Study Design. A retrospective study of 16 patients who underwent the m odified Robinson anterior cervical discectomy and fusion at three oper ative levels. Objectives. To provide long-term follow-up data on the s urgical success and patient outcome of three-level anterior cervical d iscectomies and fusions. Summary of Background Data. The success of ar throdesis for anterior cervical fusion depends on several factors, inc luding the number of surgical levels. To the authors' knowledge, there are no long-term follow-up reports to describe the arthrodesis rate a nd outcome for patients having specifically three-level discectomy and fusion procedures. Methods. Sixteen patients, with an average age of 59 years, were followed for an average of 37 months. All had an anteri or discectomy, burring of the endplates, and placement of an autogenou s tricortical iliac crest graft at three levels. All patients had foll ow-up office visits with examinations and radiographs. Radiographic un ion, postoperative pain relief, and neurologic recovery were evaluated . Results. Only 9 (56%) of the 16 patients went on to achieve solid ar throdesis at all three levels. Of the seven patients with pseudarthros is, two had severe pain and required revision; two had moderate pain a nd three no pain. Of the nine with the solid fusion, three had mild pa in and six no pain, a statistically significant difference in comparin g the two outcomes (P < 0.01). All patients with preoperative motor de ficit recovered, but two patients in whom a pseudarthrosis had develop ed had limited improvement in function until the nonunion was surgical ly repaired. Conclusions, A three-level modified Robinson cervical dis cectomy and fusion results in an unacceptably high rate of pseudarthro sis. Although not all pseudarthroses are painful, these data suggest t hat those with a successful fusion have a better outcome. It is recomm ended that these patients undergo additional or alternative measures t o achieve arthrodesis consistently.