137. Correction, maintenance of cervical alignment and revision rates: three-level ACDF versus corpectomy ACDF hybrid procedures

Abstract

<h3>BACKGROUND CONTEXT</h3> Anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), and hybrids (combination ACCF-ACDF) are common procedures used to treat symptomatic cervical spondylosis. Although there is a relative abundance of literature comparing 1-level ACCF vs 2-level ACDF and 2-level ACCF vs 3-level ACDF, detailed comparisons of 3-level ACDF vs hybrid procedures have not been extensively addressed. <h3>PURPOSE</h3> The objective of this study is to compare 3 and 12-month radiographic sagittal parameters and patient reported outcomes (PROs) in patients who underwent 3-level ACDF or a hybrid procedure. <h3>STUDY DESIGN/SETTING</h3> Longitudinal observational comparative cohorts from a large, multisurgeon database. <h3>PATIENT SAMPLE</h3> Patients who underwent a 3-level ACDF (3L-ACDF, N=47) or 1-level corpectomy/1-level ACDF (Hybrid, N=52) with at least a 12-month postop data available were identified. <h3>OUTCOME MEASURES</h3> EuroQOL-5D (EQ-5D), Neck Disability Index (NDI), neck and arm pain. <h3>Methods</h3> Standard demographic, surgical and (PROs) were collected in addition to pre- and postoperative radiographic data including C2 plumb line (C2PL), C2-C7 lordosis (CL), segmental lordosis (SL), and T1 slope (T1S). <h3>Results</h3> The two cohorts were similar in terms of demographics at baseline. At 3 months postop, CL (9.04°vs -2.12°, p=0.00) and SL (6.06°vs -2.26°, p=0.003) were significantly greater in the 3L-ACDF group versus the HYBRID group. This significant difference was maintained at 12 months postop for CL (6.62°vs -0.60°, p=0.015) but not for SL (2.36°vs -1.09°, p=0.199). There were no differences in PROs between the two groups prior to surgery, at 3 months postop, or at 12 months postop. Seven patients required revision surgery in the 1-year study period (1 in the 3L-ACDF, and 6 in the Hybrid p<0.001). <h3>Conclusions</h3> Three-level ACDF resulted in greater C2-C7 lordosis and segmental lordosis postoperatively, which was maintained at 1 year for cervical lordosis. While patient reported outcomes were similar between the groups, patients with hybrid instrumentation required significantly more revision surgeries than those treated with 3-level ACDF. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.