One-level ACDF patients had better 5-year outcomes than multi-level patients

ORLANDO, Fla. — One-level and two-level anterior cervical discectomy and fusion procedures offered patients with symptomatic cervical degenerative disc disease similar health outcomes in a recent study, but single-level procedures showed better results in patients for several key data points, according to a recent presentation.

Perspective from Jeffrey L. Gum, MD

“The outcomes were generally similar, but single level ACDF (anterior cervical discectomy and fusion) patients tended to show better improvements in most data points, and the single-level group showed statically significant greater improvement than the two-level patients, such as fusion rate, Neck Disability Index improvement, and the physical component scores,” Jack E. Zigler, MD, said at the Cervical Spine Research Society Annual Meeting, here.

Zigler presented a study that compared the results of one-level and two-level ACDF procedures in patients with similar demographic who participated in the fusion control arm of the Mobi-C Cervical Disc Prosthesis investigational device exemption FDA study (LDR Medical; Troyes, France), which included 81 patients who underwent one-level ACDF and 105 patients who underwent two-level ACDF.

The patients were followed up for 5 years, minimum, with Neck Disability Index scores, VAS scores for neck and arm pain, fusion rates and adjacent segment degeneration outcomes. Zigler and colleagues then compared the outcomes in the two groups.

At 4 years, the fusion rate in patients who underwent ACDF at one level was 93.3% and in patients who underwent ACDR at two levels it was 86.1%, which was a statistically significant difference, according to Zigler.

SF-12 physical component scores statistically improved more in the patients with one-level ACDF than two-level ACDF, Zigler noted.

While single-level ACDF showed better outcomes, patients undergoing any ACDF procedure saw improved results postoperatively, he said.

“Both groups improved significantly after surgery and maintained their improvements from their baseline preop state through 5 years, so this is a very durable procedure,” Zigler said. – by Robert Linnehan

Reference:

Zigler JE. Paper #21. Presented at: Cervical Spine Research Society Annual Meeting; Dec. 4-6, 2014; Orlando, Fla.

Disclosure: Zigler has no relevant financial disclosures.

Perspective

Jeffrey L. Gum, MD

The authors have utilized a unique opportunity to examine a common clinical scenario. I agree that, indeed, most surgeons likely feel comfortable offering 2-level ACDF (anterior cervical discectomy and fusion) with the intuition that outcomes are similar to single-level ACDF. Inclusion criteria for FDA-IDE (investigational device exemption) trials are strict, providing their sub-analysis of the control arm of the Mobi-C trial an extremely well-matched cohort to answer the study question.

I also agree with the authors’ conclusions that patients undergoing 2-level ACDF did not do as well as those who underwent single-level ACDF. Overall, both groups did well though and I think the authors should emphasize the change from baseline. Patients undergoing 2-level ACDF, in theory, should have more severe pathology and likely a worse baseline.

Therefore, it is important to not only compare 4-year outcomes between both cohorts, but the change from baseline. This work will make a nice addition to our current literature and aid in counseling patients prior to 1-level vs 2-level ACDF.

Jeffrey L. Gum, MD

Norton Leatherman Spine Center

Louisville, KY.

Disclosures: Gum has no relevant financial disclosures.