Correction and Maintenance of Cervical Alignment: 3-Level ACDF Versus Corpectomy-ACDF "Hybrid" Procedures. Issue 4 (9th May 2023)

• Record Type: Journal Article
• Authors: Campion, Chad; Crawford, Charles H.; Glassman, Steven D.; Berkay, Fehmi; Mkorombindo, Tino; Carreon, Leah Y.
• Is Part Of: Clinical spine surgery. Volume 36:Issue 4(2023)
• Page Start: E118
• Page End: E122
• Publication Date: 2023-05-09
• Subjects: ACDF -- anterior cervical discectomy and fusion -- cervical corpectomy -- sagittal alignment -- neck disability index; Spinal cord -- Diseases -- Periodicals; Spinal cord -- Surgery -- Periodicals; 617.56059
• DOI: 10.1097/BSD.0000000000001392
• Languages: English
• ISSNs: 2380-0186

Abstract

Abstract : Study Design: Longitudinal observational comparative cohorts. Objective: The objective of this study is to compare 3 and 12-month radiographic sagittal parameters and patient-reported outcomes (PROs) in patients who underwent 3-level ACDF or a hybrid procedure. Summary of Background Data: Anterior Cervical Discectomy and Fusion (ACDF), Anterior Cervical Corpectomy and Fusion (ACCF), and hybrids (combination ACCF-ACDF) are common procedures used to treat symptomatic cervical spondylosis. Although there is a relative abundance of literature comparing 1-level ACCF versus 2-level ACDF and 2-level ACCF versus 3-level ACDF, detailed comparisons of 3-level ACDF versus hybrid procedures have not been extensively addressed. Methods: Patients who underwent a 3-Level ACDF (3L-ACDF, N=47) or 1-Level Corpectomy/1-Level ACDF (Hybrid, N=52) with at least a 12-month post-op data available were identified. Standard demographic, surgical and PROs were collected in addition to preoperative and postoperative radiographic data, including C2 plumb line (C2PL), C2–C7 lordosis (CL), segmental lordosis (SL), and T1 slope (T1S). Results: The 2 cohorts were similar in terms of demographics. At 3 months post-op, CL (9.04° vs. −2.12°, P =0.00) and SL (6.06° vs. −2.26°, P =0.003) were significantly greater in the 3L-ACDF group versus the HYBRID group. This significant difference was maintained at 12 months postoperative for CL [(6.62° vs. −0.60°, P =0.015) but not for SL (2.36° vs. −1.09°, P =0.199)]. There were no differences in PROs between the 2 groups before surgery, at 3 months postoperative or 12 months postoperative. Seven patients required revision surgery in the 1-year study period (1 in the 3L-ACDF, and 6 in the Hybrid P <0.001). Conclusions: Three level ACDF resulted in greater C2–C7 lordosis and segmental lordosis postoperatively, which was maintained at 1 year for cervical lordosis. While PROs were similar between the groups, patients with hybrid instrumentation required significantly more revision surgeries than those treated with 3-level ACDF.