Comparison of outcomes and complications between one- and two-level anterior cervical discectomy and fusion: a population-based study of 410 patients

Thea Overgaard Wichmann; Rachid Bech-Azeddine; Anna Louise Norling; Halldór Bjarki Einarsson; Mikkel Mylius Rasmussen

doi:10.1080/02688697.2021.2005778

Comparison of outcomes and complications between one- and two-level anterior cervical discectomy and fusion: a population-based study of 410 patients

Br J Neurosurg. 2021 Nov 25:1-6. doi: 10.1080/02688697.2021.2005778. Online ahead of print.

Authors

Thea Overgaard Wichmann¹, Rachid Bech-Azeddine^{2

3}, Anna Louise Norling², Halldór Bjarki Einarsson¹, Mikkel Mylius Rasmussen¹

Affiliations

¹ Department of Neurosurgery, Aarhus University Hospital, Aarhus N, Denmark.
² Copenhagen Spinal Research Unit - Center of Rheumatology and Spine Diseases Rigshospitalet Glostrup, Glostrup, Denmark.
³ Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark.

PMID: 34821187
DOI: 10.1080/02688697.2021.2005778

Abstract

Objective: The objective of this study was to compare outcomes and patient satisfaction, and secondly to compare complication rates between one- and two-level anterior cervical discectomy and fusion (ACDF) for cervical radiculopathy.

Methods: Data from patients receiving one- or two-level ACDF for cervical radiculopathy at two institutions were prospectively collected and retrospectively analysed. Patients were separated into one-level ACDF and two-level ACDF. Comparison analyses of patient-reported outcome measures (PROMs) comprising Visual Analogue Scale for neck pain (VAS-NP) and arm pain (VAS-AP), Neck Disability Index (NDI), and EQ-5D 3-level version (EQ-5D-3L) were performed between baseline and 1-year follow-up and between groups as well as achievement of minimal clinically important differences (MCID) in PROMs and satisfaction. Additionally, complications were compared between groups.

Results: A total of 410 patients (270 one-level and 140 two-level) were included. PROMs improved significantly from baseline to 1-year follow-up (p < 0.001) in both groups. When comparing PROMs between one- and two-level ACDF, a trend towards greater improvement was observed in patients undergoing one-level ACDF, notably in EQ-5D-3L (p = 0.073). Significantly more patients in the one-level group achieved MCID in VAS-NP compared to patients in the two-level group (56% vs 44%, p = 0.025). Two hundred and ninety-six (67%) patients reported to be satisfied, but the one-level group trended to be more satisfied (70% vs. 62%). One-level ACDF further demonstrated a trend of more favourable complication profiles; however, complication rates were low in both groups. The risk of intraoperative complications was 2.4%, postoperative complications in-hospital were 1.2%, and patient-reported postoperative events post-discharge 42%.

Conclusions: One- and two-level ACDF are effective procedures for degenerative cervical nerve root compression. Yet, significantly more patients in the one-level group achieved MCID in neck pain compared to patients in the two-level group.

Keywords: Anterior cervical discectomy and fusion; cervical radiculopathy; complications; outcomes.