Four-level Anterior Cervical Discectomy and Fusion: A Single Center Experience over a 5-year Period

Introduction: Four-level anterior cervical discectomy and fusion (ACDF) is a rare procedure compared to single or two levels, with few reports in the literature.

Methods: A single-institution retrospe ctive database was used to identify patients who underwent four-level ACDF over a 5-year period. Data for patient demographics, clinical presentation symptoms, neurological findings and radiologic examination on admission were collected. The primary outcomes evaluated were clinical and neurological, complications adverse event as well as re-operation rates.
The main outcomes that were assessed, were clinical and neurological, as well as complication and reoperation rates.

Results: Eight patients who underwent four-level ACDF between 2016 and 2021, with a minimum follow-up of 16 months were included in the analysis. The cohort consisted of 6 males (75%) and 2 females (25%), with a mean age of 56.2 years, ranging from 39 to 68years at the time of diagnosis. In 75% of the cases, neurological deficits were the most common presenting symptom. No immediate surgery-related complications or neurological deterioration were observed. At the most recent follow-up, all patients showed significant recovery of motor strength, resolution of limb sensory disturbances, and an overall fusion rate of 100%.

Conclusion : In carefully selected patients with multilevel cervical spondylotic myelopathy, a four-level anterior cervical discectomy and fusion (ACDF) is a valid managment option.