{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T18:18:55Z","timestamp":1783361935010,"version":"3.54.6"},"reference-count":25,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Anterior cervical discectomy and fusion (ACDF) is a safe and effective intervention to treat cervical spine pathology. Although these were originally performed as single-level procedures, multilevel ACDF has been performed for patients with extensive degenerative disc disease. To date, there is a paucity of data regarding outcomes related to ACDFs of 3 or more levels. The purpose of this study was to compare surgical outcomes of 3- and 4-level ACDF procedures.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>The authors performed a retrospective chart review of patients who underwent 3- and 4-level ACDF at the University of Virginia Health System between January 2010 and December 2017. In patients meeting the inclusion\/exclusion criteria, demographics, fusion rates, time to fusion, and reoperation rates were evaluated. Fusion was determined by &lt; 1 mm of change in interspinous distance between individual fused vertebrae on lateral flexion\/extension radiographs and lack of radiolucency between the grafts and vertebral bodies. Any procedure requiring a surgical revision was considered a failure.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Sixty-six patients (47 with 3-level and 19 with 4-level ACDFs) met the inclusion\/exclusion criteria of having at least one lateral flexion\/extension radiograph series \u2265 12 months after surgery. Seventy percent of 3-level patients and 68% of 4-level patients had \u2265 24 months of follow-up. Ninety-four percent of 3-level patients and 100% of 4-level patients achieved radiographic fusion for at least 1 surgical level. Eighty-eight percent and 82% of 3- and 4-level patients achieved fusion at C3\u20134; 85% and 89% of 3- and 4-level patients achieved fusion at C4\u20135; 68% and 89% of 3- and 4-level patients achieved fusion at C5\u20136; 44% and 42% of 3- and 4-level patients achieved fusion at C6\u20137; and no patients achieved fusion at C7\u2013T1. Time to fusion was not significantly different between levels. Revision was required in 6.4% of patients with 3-level and in 16% of patients with 4-level ACDF. The mean time to revision was 46.2 and 45.4 months for 3- and 4-level ACDF, respectively. The most common reason for revision was worsening of initial symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>The authors\u2019 experience with long-segment anterior cervical fusions shows their fusion rates exceeding most of the reported fusion rates for similar procedures in the literature, with rates similar to those reported for short-segment ACDFs. Three-level and 4-level ACDF procedures are viable options for cervical spine pathology, and the authors\u2019 analysis demonstrates an equivalent rate of fusion and time to fusion between 3- and 4-level surgeries.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2020.6.spine20171","type":"journal-article","created":{"date-parts":[[2020,10,9]],"date-time":"2020-10-09T07:20:07Z","timestamp":1602228007000},"page":"45-51","source":"Crossref","is-referenced-by-count":13,"title":["A single-center retrospective analysis of 3- or 4-level anterior cervical discectomy and fusion: surgical outcomes in 66 patients"],"prefix":"10.3171","volume":"34","author":[{"given":"Jesse J.","family":"McClure","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhargav D.","family":"Desai","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leah M.","family":"Shabo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas J.","family":"Buell","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Po","family":"Yen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin S.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher I.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia; and"},{"name":"Department of Neurosurgery, Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark E.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avery L.","family":"Buchholz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"b1","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"476","DOI":"10.1097\/BRS.0000000000000165","article-title":"Current trends in demographics, practice, and in-hospital outcomes in cervical spine surgery: a national database analysis between 2002 and 2011","volume":"39","author":"Marquez-Lara A","year":"2014","unstructured":"Marquez-Lara A, Nandyala SV, Fineberg SJ, Singh K. 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