Four- and five-level anterior cervical discectomy and fusion with iliac crest autologous bone graft and plate-screw fixation: Radiographic and clinical outcomes with minimum 2-year follow-up.

BACKGROUND: In multilevel disease, the risks and benefits of performing anterior versus posterior surgical approaches to the cervical spine remain debated. We sought to evaluate the radiographic and clinical outcomes of patients with multilevel cervical spondylotic myelopathy (CSM) treated with four- and five-level anterior cervical discectomy and fusion (ACDF), using tricortical iliac crest autograft and anterior plate fixation. MATERIALS AND METHODS: Between 2009 and 2021, 1428 patients who underwent cervical fusion were reviewed. Inclusion required four- or five-level ACDF fusion with a 2-year clinical follow-up. Exclusions required fusions <4 levels; corpectomies; additional posterior fixation; and surgeries for infection, trauma, or malignancy. Demographics, preoperative and postoperative Nurick grades, Visual Analog Scale (VAS) pain scores, radiographic alignment (C2-C7 Cobb angle, T1 slope [T1S]), and fusion status were collected. Postoperative complications were categorized as early (0-3 months), intermediate (3-12 months), and late (13-24 months). RESULTS: Twenty-seven patients (63% of males), age 59.7 ± 8.6 years, were included. Twenty-two patients underwent four-level and 5 underwent five-level ACDF. Significant improvements were observed in Nurick grade (2.78-1.15, P < 0.001), VAS score for neck and arm pain (both P < 0.001), Cobb angle (8.45°-13.39°, P = 0.001), and T1S (28.81°-32.36°, P < 0.001). Dysphagia was the most common early complication (29.6%), decreasing to 7.4% at late follow-up. Three patients (11.1%) developed adjacent segment disease. All patients achieved radiographic fusion. CONCLUSION: Four- and five-level ACDF with tricortical iliac crest autograft yields excellent clinical and radiographic outcomes in patients with multilevel CSM, with high fusion rates and low complication profile over a 2-year follow-up. LEVEL OF EVIDENCE: IV (retrospective case series).