Postoperative outcomes of multilevel versus single-level anterior cervical discectomy and fusion in patients with sarcopenia: a matched cohort study.

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) remains an effective treatment for cervical degenerative pathology. However, postoperative outcomes among patients with sarcopenia following multilevel versus single-level ACDF remain poorly understood. This study compared postoperative outcomes and complications between multilevel and single-level ACDF in patients with sarcopenia. METHODS: A retrospective propensity-matched cohort study was conducted using the TriNetX database, including 2,873 patients with sarcopenia identified using International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) diagnostic codes who underwent single-level or multilevel ACDF between 2006 and 2026. One-to-one exact matching was done to control variables across multi-level ACDF and single-level ACDF cohorts. Short-term outcomes were assessed at 3 and 6 months, while long-term outcomes were evaluated at 1 and 2 years. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Independent t-tests and Chi-squared analyses were performed to compare continuous and categorical variables, respectively. RESULTS: Sarcopenic multilevel ACDF patients demonstrated significantly higher rates of rehabilitation utilization, opioid use, and pseudoarthrosis during short-term follow-up, with persistent higher rates of pseudoarthrosis during long-term follow-up. At 3 months, multilevel ACDF patients demonstrated higher rehabilitation utilization (51.1% vs. 45.5%, OR 1.25, P=0.006), opioid use (88.7% vs. 82.6%, OR 1.65, P<0.001), and pseudoarthrosis (9.3% vs. 6.7%, OR 1.42, P=0.02). At 6 months, multilevel ACDF patients continued to demonstrate higher rehabilitation utilization (54.6% vs. 48.4%, OR 1.28, P=0.003), opioid use (88.8% vs. 82.6%, OR 1.67, P<0.001), and pseudoarthrosis (10.7% vs. 7.9%, OR 1.40, P=0.02). At 1-year, multilevel ACDF patients demonstrated higher pseudoarthrosis (12.1% vs. 9.2%, OR 1.36, P=0.02) and new postoperative dysphagia (13.7% vs. 10.2%, OR 1.41, P=0.02). CONCLUSIONS: Sarcopenic patients undergoing multilevel ACDF demonstrated higher rates of postoperative opioid use, rehabilitation utilization, pseudoarthrosis, and new postoperative dysphagia compared with those undergoing single-level ACDF. These findings should be considered for careful preoperative risk assessment, patient counseling, and postoperative monitoring.