title: Three- and four-level anterior cervical discectomy and fusion with plate fixation: a prospective study.
abstract: METHODS
  A prospective study of 15 patients who underwent modified Smith-Robinson anterior cervical discectomy and fusion at three or four operative levels stabilized with an unicortical anterior plate.
  
  
  OBJECTIVE
  To provide medium-term follow-up data on the surgical success and patient outcome of three- and four-level anterior cervical discectomies and fusions and to determine the effect that plate fixation has on the results.
  
  
  BACKGROUND
  The success of arthrodesis for anterior cervical fusion depends on several factors, including the number of surgical levels. The arthrodesis rate and outcome for patients having three- and four-level discectomy and fusion procedures is disappointing. Internal fixation putatively improves these parameters.
  
  
  METHODS
  Fifteen patients (average age, 51 years; range, 35-77), were observed for an average of 42 months (range, 25-73) All had an anterior discectomy, burring of the endplates, placement of an autogenous tricortical iliac crest graft at three (12 patients) or four (3 patients) levels, and application of a Cervical Spine Locking Plate. All patients had follow-up office visits with examinations and radiographs. Radiographic union, postoperative pain relief, and neurologic recovery were evaluated.
  
  
  RESULTS
  Solid arthrodesis was achieved at all levels in only 7 (47%) of the 15 patients after a single procedure. Of the 8 patients with pseudarthrosis, 3 had sufficient pain to necessitate revision surgery (with pain relief in two), 1 had pain without further surgery, and 4 no pain. Of the 7 with solid fusion, 3 had persistent pain, and 4 had none. Two in this group had a second procedure. All 4 patients with preoperative myelopathy improved, and 10 of the 11 with radiculopathy had resolution of arm symptoms.
  
  
  CONCLUSIONS
  Three- and four-level modified Robinson cervical discectomy and fusion results in an unacceptably high rate of pseudarthrosis. The Cervical Spine Locking Plate alone does not appear to improve the arthrodesis rate.
authors.affiliation: Department of Orthopaedic Surgery, The University of Texas Southwestern Medical Center, Dallas 75235-8883, USA. michael.bolesta@email.swmed.edu
authors.forename: M J
authors.initials: MJ
authors.lastname: Bolesta
authors.forename: G R
authors.initials: GR
authors.lastname: Rechtine
authors.forename: A M
authors.initials: AM
authors.lastname: Chrin
mesh_terms: D000328:Adult; D000368:Aged; D001860:Bone Plates / Q000592:standards*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D017586:Diskectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D011859:Radiography; D020127:Recovery of Function; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome