title: Three-level anterior cervical discectomy and fusion: radiographic and clinical results.
abstract: METHODS
  A retrospective study of 16 patients who underwent the modified Robinson anterior cervical discectomy and fusion at three operative levels.
  
  
  OBJECTIVE
  To provide long-term follow-up data on the surgical success and patient outcome of three-level anterior cervical discectomies and fusions.
  
  
  BACKGROUND
  The success of arthrodesis for anterior cervical fusion depends on several factors, including the number of surgical levels. To the authors' knowledge, there are no long-term follow-up reports to describe the arthrodesis rate and outcome for patients having specifically three-level discectomy and fusion procedures.
  
  
  METHODS
  Sixteen patients, with an average age of 59 years, were followed for an average of 37 months. All had an anterior discectomy, burring of the endplates, and placement of an autogenous tricortical iliac crest graft at three levels. All patients had follow-up office visits with examinations and radiographs. Radiographic union, postoperative pain relief, and neurologic recovery were evaluated.
  
  
  RESULTS
  Only 9 (56%) of the 16 patients went on to achieve solid arthrodesis at all three levels. Of the seven patients with pseudarthrosis, two had severe pain and required revision; two had moderate pain and three no pain. Of the nine with the solid fusion, three had mild pain and six no pain, a statistically significant difference in comparing the two outcomes (P < 0.01). All patients with preoperative motor deficit recovered, but two patients in whom a pseudarthrosis had developed had limited improvement in function until the nonunion was surgically repaired.
  
  
  CONCLUSIONS
  A three-level modified Robinson cervical discectomy and fusion results in an unacceptably high rate of pseudarthrosis. Although not all pseudarthroses are painful, these data suggest that those with a successful fusion have a better outcome. It is recommended that these patients undergo additional or alternative measures to achieve arthrodesis consistently.
authors.affiliation: Department of Orthopaedic Surgery, University Hospitals Spine Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, USA.
authors.forename: S E
authors.initials: SE
authors.lastname: Emery
authors.forename: J R
authors.initials: JR
authors.lastname: Fisher
authors.forename: H H
authors.initials: HH
authors.lastname: Bohlman
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D017586:Diskectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009048:Motor Skills; D009460:Neurologic Examination; D010146:Pain / Q000209:etiology; D011183:Postoperative Complications; D011859:Radiography; D012189:Retrospective Studies; D013123:Spinal Fusion