Comparing ACDF Outcomes by Cervical Spine Level: A Single Center Retrospective Cohort Study

Article Figures & Data

Table 1

Baseline patient demographics.^{^a}

Abbreviations: ACDF, anterior cervical discectomy and fusion; BMI, body mass index; MLCF, middle-to-lower cervical fusion; UCF, upper cervical fusion.
Note: Boldface indicates statistically significant comparison.
↵a Patients were classified as UCF or MLCF based on the inclusion of C3 to C4 level in the ACDF construct.

Table 2

Clinical and surgical characteristics of patients undergoing ACDF with either UCF or MLCF.^{^a}

Characteristics	MLCF (n = 562)	UCF (n = 281)	P
Neurological diagnosis, % (n)			<0.0001
Myelopathy	48.8 (274)	63.0 (177)
Radiculopathy	33.1 (186)	11.4 (32)
Myelopathy and radiculopathy	18.2 (102)	25.6 (72)
SCSC observed presurgery, % (n)	14.8 (83)	22.8 (64)	0.004
Spondylolisthesis diagnosis, % (n)	9.4 (53)	13.5 (38)	0.071
Extremities with NS, % (n)			0.061
Upper	66.7 (375)	58.0 (163)
Lower	2.7 (15)	3.9 (11)
Upper and lower	28.6 (161)	36.7 (103)
Not available	2.0 (11)	1.4 (4)
ASA classification, % (n)			0.377
I	0.7 (4)	0.7 (2)
II	50.0 (281)	43.8 (123)
III	48.0 (270)	54.5 (153)
IV	1.3 (7)	1.1 (3)
Approach surgeon utilized, % (n)	3.9 (22)	3.6 (10)	0.800
Graft used, % (n)	92.7 (521)	94.7 (266)	0.282
Neuromonitoring used, % (n)	53.9 (303)	49.8 (140)	0.262
Fusion device, % (n)			0.884
Plate alone	50.0 (281)	50.5 (142)
Plate + cage	50.0 (281)	49.5 (139)

Abbreviations: ACDF, anterior cervical discectomy and fusion; ASA, American Society of Anesthesiologists; MLCF, middle-to-lower cervical fusion; NS, neurological symptoms; SCSC, spinal cord signal change; UCF, upper cervical fusion.
Note: Boldface indicates statistically significant comparison.
↵a Patients were classified as UCF or MLCF based on the inclusion of C3 to C4 level in the ACDF construct.

Table 4

Primary and secondary outcomes of patients undergoing ACDF with either UCF or MLCF.^{^a}

Abbreviations: ACDF, anterior cervical discectomy and fusion; CI, confidence interval; LOS, length of stay; MLCF, middle-to-lower cervical fusion; NS, neurological symptoms; UCF, upper cervical fusion.
Note: Boldface indicates statistically significant comparison.
↵a Patients were classified as UCF or MLCF based on the inclusion of C3 to C4 level in the ACDF construct.

Table 5

OR and aOR of event for a subgroup^{^a} of patients undergoing ACDF with upper cervical fusion (UCF) or middle-lower cervical fusion (MLCF).^{^b}

Characteristics	OR (95% CI)	aOR^{^c} (95% CI)
Inpatient/outpatient rehabilitation discharge	2.43 (1.54, 3.84)	1.70 (0.99, 2.90)
Postsurgery NS resolved/got better (n = 618)	0.43 (0.30, 0.62)	0.46 (0.30, 0.70)
Complications
At least 1 major complication	1.20 (0.79, 1.82)	1.22 (0.75, 1.98)
New neurological deficit	1.00 (0.52, 1.93)	1.66 (0.76, 3.63)
Revision surgery	1.47 (0.69, 3.15)	0.99 (0.40, 2.43)
At least 1 minor complication	1.89 (1.34, 2.66)	1.83 (1.24, 2.72)
Dysphagia	1.72 (1.18, 2.49)	1.66 (1.08, 2.56)

Abbreviations: ACDF, anterior cervical discectomy and fusion; aOR, adjusted OR; MLCF, middle-to-lower cervical fusion; NS, neurological symptoms; UCF, upper cervical fusion.
Note: Estimates that are bolded are significantly different from 1 (P < 0.05).
↵a The current analysis included only African American/Black and Caucasian/White patients. The models failed to converge when including other race categories due to small cell counts.
↵b Patients were classified as UCF or MLCF based on the inclusion of C3 to C4 level in the ACDF construct.
↵c aOR was calculated including age, sex, race, insurance type, number of levels fused, spinal cord signal change, and diagnosis as covariates.