Three-level Anterior Cervical Discectomy And Fusion Research Articles

P57. Are preoperative PHQ-9 scores predictive of postoperative outcomes improvement following anterior cervical discectomy and fusion?

BACKGROUND CONTEXT Few studies have quantified depression symptoms in the preoperative period using a validated metric such as Patient Health Questionnaire-9 (PHQ-9) and have tracked patient-reported outcomes (PROs) following common spinal procedures, such as an anterior cervical discectomy and fusion (ACDF). PURPOSE This study aims to determine if there is an association between preoperative depression, as quantified by PHQ-9, and postoperative improvement in pain and disability after an ACDF. STUDY DESIGN/SETTING Retrospective. PATIENT SAMPLE A total of 119 patients undergoing a primary, one- to three-level ACDF. OUTCOME MEASURES NDI, VAS Neck and Arm Pain, SF-12 PCS. METHODS Patients undergoing a primary, 1- to 3-level ACDF were retrospectively reviewed and stratified by their preoperative PHQ-9 score: minimal to no depression ( RESULTS A total of 119 patients were included: 51 had a preoperative PHQ-9 score CONCLUSIONS In this study, we identified patients with mild to severe depression symptoms using PHQ-9 and compared outcomes following ACDF to patients with no depression symptoms. Patients with worse preoperative mental health reported significantly greater preoperative disability and pain. However, both cohorts demonstrated similar clinical recovery at 1-year follow-up. These findings suggest patients with worse preoperative mental health can expect significant improvements in PROs following surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Sagittal Alignment Outcomes in Lordotic Cervical Spine: Does Three-Level Anterior Cervical Discectomy and Fusion Outperform Laminoplasty?

A prospective cohort study. To compare the radiological outcomes between three-level anterior cervical discectomy and fusion (ACDF) and plate-only open-door laminoplasty (LAMP) in patients with lordotic cervical spine. Both three-level ACDF and LAMP are important surgical methods for multilevel cervical spondylotic myelopathy, but the cervical sagittal alignment outcomes and the lordosis preserving abilities between the two specific approaches have not been carefully compared. Sixty patients, all of whom had lordotic cervical spines and underwent three-level ACDF (n = 22) or LAMP (n = 38) for the treatment of multilevel cervical spondylotic myelopathy, were prospectively studied. Upright neutral cervical lateral radiographs were assessed preoperatively, at 3 days after surgery, and at the last follow-up (1.5 years). The primary radiological outcomes are C2-7 Cobb angle, and the secondary outcomes include C2-7 sagittal vertical axis , disc height, Harrison angle, and Ishihara index. The relationship between preoperative parameters and follow-up outcomes were assessed. Preoperative cervical sagittal alignment parameters were similar between the two groups. Patients in the ACDF group obtained larger C2-7 Cobb angles than those the LAMP group early after surgery. However, the lordosis in the ACDF group decreased significantly during follow-up, leading to similar outcomes between the two groups. The lordosis-preserving ability of ACDF is significantly poorer than that of LAMP. Secondary radiological parameters also showed similar trends. In both groups, the preoperated Ishihara index was significantly related to follow-up C2-7 Cobb angles. For patients with Ishihara index less than 20, ACDF is more likely to produce a larger C2-7 Cobb angled at the time of follow-up. In patients with lordotic cervical spine, the sagittal alignment outcomes of the two approaches were similar, and the lordosis-preserving ability was poorer in ACDF. Further research should focus on the factors related to the lordosis-preserving ability of multilevel ACDF. 3.

Rigid-Plating and Cortico-Cancellous Allograft Are Effective for 3-Level Anterior Cervical Discectomy and Fusion: Radiographic and Clinical Outcomes

ObjectiveTo determine the risk factors associated with radiographic changes and clinical outcomes following 3-level anterior cervical discectomy and fusion (ACDF) using rigidplate constructs and cortico-cancellous allograft. ACDF has demonstrated efficacy for treatment of multilevel degenerative cervical conditions, but current data exists in small heterogeneous forms. MethodsA retrospective review included 98 patients with primary 3-level ACDF surgery at one institution from 2008 to 2013 with minimum 1-year follow-up. Cervical sagittal vertical axis (SVA), segmental height, fusion, and lordosis radiographs were measured preoperatively and at 2 postoperative periods. ResultsRates of asymptomatic pseudarthroses and total reoperations were 18% and 4%, respectively. Results demonstrated immediate improvements in cervical lordosis (5.5°, p < 0.01) and segmental height (5.0-mm increase, p < 0.01) with little changes in the cervical SVA (3.2-mm increase, p < 0.01). The segmental height decreased from immediate postoperative period to final follow-up (1.7-mm decrease, p < 0.01). Older age was protective against radiolucent lines (p < 0.05). Patient-reported outcomes significantly improved following surgery (p < 0.01). Current smoking status and diagnosis of diabetes mellitus had no impact on radiographic or clinical outcomes. Risk factors were not identified for the 5 reoperations (4%). ConclusionThree-level ACDF with rigid-plating and cortico-cancellous allograft is an effective procedure for degenerative diseases of the cervical spine without the application of additional adjuncts or combined anteriorposterior cervical surgeries. Significant improvements in cervical lordosis, segmental height, and segmental alignment can be achieved with little change in cervical SVA and a low rate of reoperations over short-term follow-up. Similarly, patient-reported outcomes show significant improvements.

Friday, September 28, 2018 4:05 PM–5:05 PM abstracts: new concepts: cervical spine: 243. Rigid plating and cortico-cancellous allograft are effective for three-level anterior cervical discectomies and fusion: a radiographic study

BACKGROUND CONTEXT Anterior cervical discectomy and fusion (ACDF) has been associated with successful outcomes for a variety of degenerative conditions of the cervical spine via neural decompression and stabilization. ACDF for one or two levels using allograft and rigid plating gives a high union rate with good clinical outcome. However, concerns regarding the potential stress-shielding associated with rigid plating, the lack of healing potential with allograft, pseudarthrosis, subsidence, loss of lordosis and reoperation have previously been discussed, particularly for multilevel cases. PURPOSE The purpose of the current study is to detail the radiographic and clinical outcomes of a series of three-level primary ACDF procedures using a rigid construction with cortico-cancellous allograft at a single institution. STUDY DESIGN/SETTING Retrospective cohort series. PATIENT SAMPLE A retrospective review was performed on 98 patients who underwent a primary three-level ACDF with rigid plating and cortico-cancellous allograft by a single-surgeon from 2008 to 2014 with a minimum of 1-year follow-up. Exclusion criteria included revision surgeries, infections, anterior or posterior surgeries, and follow-up of less than 12 months. OUTCOME MEASURES Demographics, perioperative data, and complications were recorded. Preoperative, 2-week postoperative, and final follow-up images were reviewed to evaluate cervical sagittal vertical axis (SVA), segmental height, fusion, cervical lordosis, and fusion. Patient reported outcomes were obtained in the form of Neck Disability Index (NDI) scores and Visual Analog Scales (VAS) scores for the neck and arm. METHODS Radiographic measurements from preoperative, immediate postoperative, and final follow-up were compared using Student's t-tests. Bivariate and multivariate analyses were used to identify risk factors for patient report and radiographic outcomes such as: reoperations, graft lucencies, loss of lordosis, loss of segmental height, and progressive cervical SVA. RESULTS Average follow-up was 24.7±13.2 months. Rates of asymptomatic radiographic lucencies and total reoperations were 18% (17 patients) and 4% (4 patients) respectively. Immediate improvements in cervical lordosis (5.5°, p CONCLUSIONS Three-level ACDF with rigid-plating and cortico-cancellous allograft is an effective procedure for degenerative diseases of the cervical spine without the application of additional adjuncts or combined anterior-posterior cervical surgeries. Significant improvements in cervical lordosis, segmental height, and segmental alignment can be achieved with little change in cervical SVA and a low rate of reoperations over short-term follow-up. Similarly, patient reported outcomes show significant improvements following these three-level ACDF procedures.

Is stand alone PEEK cage the gold standard in multilevel anterior cervical discectomy and fusion (ACDF)? Results of a minimum 1-year follow up

IntroductionThis study was designed to evaluate the clinical and radiologic results of stand-alone synthetic polyetheretherketone (PEEK) cages for two- or three-level anterior cervical discectomy and fusion (ACDF), with a focus on subsidence. Materials and methodsWe retrospectively reviewed a total of 68 patients who underwent two- or three-level ACDF with a stand-alone PEEK cage between April 2005 and August 2016. Radiologic parameters were assessed on lateral radiographs, and fusion was assessed on computed tomography scans. For the evaluation of clinical outcomes, visual analogue scale, neck disability index, and modified Japanese Orthopedic Association scores were measured. ResultsAmong the total of 68 patients with a total of 144 segments, ACDF at two and three levels was performed in 60 and 8 patients, respectively, with a mean follow-up duration of 27.6 months. The overall fusion rate was 81.3% (117 of 144 segments), and subsidence occurred in 63 segments (43.8%) at the last follow-up. There was no statistically significant difference between the subsidence group and the nonsubsidence group in terms of fusion rate, radiologic outcomes, and clinical outcomes (p > .05). ConclusionSubsidence might be an inevitable course and only a radiologic phenomenon with no effect on the clinical and radiologic outcomes of the use of stand-alone cages.

A new source of autograft bone for interbody fusion in anterior cervical discectomy and fusion surgery: experience in 893 cases

Purpose: This study is to share our experience of a modified anterior cervical discectomy and fusion (ACDF) procedure with a new source of autograft bone for interbody fusion.Methods: The same procedure was performed in 893 cases where autograft was obtained from the osteophytes and/or the reams of vertebrae. For each case, radiological fusion rate and clinical outcome were followed up for 3 and 12 months after surgery.Results: For one to three-level ACDF, fusion rates were from 67.8% to 75.4% at 3 months follow-up, and 92% to 98.8% at 12 months follow-up. Patients’ VAS, NDI, JOA and SF-36 score improve significantly at 12 months follow-up.Conclusion: Osteophytes and vertebral reams can be a reliable source of bone graft that leads to high fusion rate and successful clinical outcome while avoiding all the problems with the current bone grafting methods used in ACDF surgery.

Comparison of three-level anterior cervical discectomy and fusion using iliac crest bone graft and plate vs interbody cages with allograft and plate

Anterior cervical plate fixation is believed to stabilize the operative motion segments, decreasing graft migration and preventing graft collapse that could lead to loss of cervical lordosis, malunion or nonunion and neurologic compromise. Although reports have noted high fusion rates in plated multilevel anterior cervical discectomy and fusion (ACDF) that range from 47% to 100% and are dependent on the number of levels fused, the efficacy of the combination of a titanium cage with allograft in comparison with autograft in such patients has not been investigated. We retrospectively analyzed 36 cases of three-level ACDF with anterior semi rigid plating. All cases were performed between August 2000 and June 2005. There were 19 males and 17 females with an average age of 51.6 (range from 35 to 69). Operated levels were C4-C7 in 30 patients, C3-C6 in 5 and C5-T1 in one patient. Nineteen patients (52%) had autologous iliac crest tricortical grafts, 17 (47%) had PEEK cages placed filled with allografts. The technique was the same in all cases: a standard left anteromedial approach to the cervical spine. The intervertebral discs were removed. All patients had burring of the end plates, 2 mm distraction and countersinking of the grafts by 2 mm from the anterior vertebral border. The autologous bone graft was tricortical and was harvested from the iliac crest using a low speed oscillating saw. The allograft used was fresh frozen, vacuum sealed cancellous chips and putty. An anterior cervical titanium plate was selected with variable angle locked screws. Clinical and radiographic data at 1 and 2 years postoperatively were obtained. Clinical outcome was assessed on 1 and 2 year follow-up and rated according to the Odom criteria. Fusion was achieved in 18 (94%) of the iliac crest group and 12 (71%) of the PEEK cage-allograft group. 1 patient in the iliac crest group and 5 in the cage-allograft group developed nonunions. Clinical outcome at 2 years was excellent in 5, good in 12 and fair in 2 patients of the iliac crest group. On the cage-allograft group it was excellent in 3, good in 13 and fair in 1. The 5 nonunions had good clinical outcome and 1 fair. We concluded that although autograft is the gold standard for 3 level ACDF, the use of allograft has the same functional status irrespective of the higher number of pseudarthrosis. The decision to use an autograft or a cage and an allograft for ACDF is therefore based mainly on personal preferences.

Discectomía y fusión cervical anterior a tres niveles con auto y aloinjerto

Anterior cervical plate fixation is believed to stabilize the operative motion segments, decreasing graft migration and preventing graft collapse that could lead to loss of cervical lordosis, malunion or nonunion and neurologic compromise. Although reports have noted high fusion rates in plated multilevel anterior cervical discectomy and fusion (ACDF) that range from 47% to 100% and are dependent on the number of levels fused, the efficacy of the combination of a titanium cage with allograft in comparison with autograft in such patients has not been investigated. We retrospectively analyzed 36 cases of three-level ACDF with anterior semi rigid plating. All cases were performed between August 2000 to June 2005. There were 19 males and 17 females with an average age of 51.6 (range from 35 to 69). Operated levels were C4-C7 in 30 patients, C3-C6 in 5 and C5-T1 in one patient. Nineteen patients (52%) had autologous iliac crest tricortical grafts, 17 (47%) had PEEK cages placed filled with allografts. The technique was the same in all cases: a standard left anteromedial approach to the cervical spine. The intervertebral discs were removed. All patients had burring of the end plates, 2 mm distraction and countersinking of the grafts by 2 mm from the anterior vertebral border. The autologous bone graft was tricortical and was harvested from the iliac crest using a low speed oscillating saw. The allograft used was fresh frozen, vacuum sealed cancellous chips and putty. An anterior cervical titanium plate was selected with variable angle locked screws. Clinical and radiographic data at 1 and 2 years postoperatively were obtained. Clinical outcome was assessed on 1 and 2 year follow-up and rated according to the Odom criteria. Fusion was achieved in 18 (94%) of the iliac crest group and 12 (71%) of the PEEK cage-allograft group. 1 patient in the iliac crest group and 5 in the cage-allograft group developed nonunions. Clinical outcome at 2 years was excellent in 5, good in 12 and fair in 2 patients of the iliac crest group. On the cage-allograft group it was excellent in 3, good in 13 and fair in 1. The 5 nonunions had good clinical outcome and 1 fair. We concluded that although autograft is the gold standard for 3 level ACDF, the use of allograft has the same functional status irrespective of the higher number of pseudarthrosis. The decision to use an autograft or a cage and an allograft for ACDF is therefore based mainly on personal preferences.

Prospective nonrandomized comparison of an allograft with bone morphogenic protein versus an iliac-crest autograft in anterior cervical discectomy and fusion

Background context Anterior cervical discectomy and fusion (ACDF) using autogenous iliac bone graft may lead to donor-site morbidity. This has led some surgeons to use alternatives to iliac bone graft, but often the alternatives have greater rates of nonunion and delayed union. Bone morphogenic protein (BMP) studies have found high arthrodesis rates in lumbar fusions. Purpose The objective of this pilot study was to compare the success of BMP combined with bone allograft with iliac bone autograft in ACDF patients. Study design/setting The institutional review board approved a prospective but nonrandomized study of 66 consecutive patients who had primary one- to three-level ACDF with either iliac-crest bone autograft or BMP allograft (0.9 mg BMP per level) followed prospectively over a 2- to 3-year period. Patient sample Consecutive patients who had primary one- to three-level ACDF with either iliac-crest bone autograft (n=36) or BMP-allograft (n=30). Patients in both iliac bone graft and BMP-allograft groups had comparable preoperative pain and disability. Outcome measures Visual analog scale pain, pain drawing, Oswestry index, pain medication use, opinion of treatment success, and neurological recovery. Results Given the nonrandomized nature of the study, the study groups were not matched. Within this limitation, both groups of patients had similar improvement in all outcome scales (visual analog scale pain, pain drawing, Oswestry index, pain medication use, and opinion of treatment success) and neurological recovery over the 2- to 3-year follow-up period. Patients in the iliac bone graft group had two pseudarthroses and two complications of the iliac-crest donor site. In the BMP-allograft group, one patient had a pseudarthrosis, but 50% had neck swelling presenting as dysphagia, which was substantially more common than the 14% present in the iliac bone graft group. Patients in the BMP-allograft group had slightly shorter surgery time, but implant and hospitalization costs were higher. Conclusions ACDF performed with BMP (0.9 mg BMP per level) allograft is as effective as iliac bone graft in terms of patient outcomes and fusion rates. Safety concerns related to neck swelling and higher initial costs were associated with patients in the bone morphogenic protein group.

Static versus dynamic plating for multilevel anterior cervical discectomy and fusion

Background context Dynamic anterior plates have been popularized to promote cervical spine fusion by allowing controlled settling, thereby promoting load sharing across the construct. To date these proposed benefits have been largely theoretical and there are no studies confirming any benefits over more traditional static plates. Purpose To compare the clinical and radiographic outcomes of patients undergoing an instrumented multilevel anterior cervical discectomy and fusion (ACDF) with either a static or dynamic plate design. Study design A retrospective clinical and radiographic study. Patient sample From 1997 to 2002, 52 patients with either radiculopathy or myelopathy underwent two- or three-level ACDF with either static or dynamic plate fixation. Outcome measures Functional outcome, fusion status, radiographic measurements. Methods A statically locked plating system was used in 21 patients, and a dynamic plating system was used in 31 patients. Functional outcome, fusion status, plate migration, settling, and adjacent-level disc space impingement were evaluated. Results Clinical outcome was found to be similar between the statically and dynamically plated groups. Eighty-four percent of patients in both groups experienced good or excellent results at final follow-up. We observed a higher rate of nonunion in patients treated with a dynamic plate (16% [5 of 31]) compared with a rate of 5% (1 of 21) in those patients treated with a static plate (p=.05). Settling of the construct and plate migration was similar between the study groups at all time points. Conclusions This study failed to confirm our hypothesis that a dynamic plate (that allows angular motion between the screws and plate) confers any clinical or radiographic advantage over earlier design static plates. A higher rate of nonunion was actually seen in the dynamically plated patients; however, clinical results were similar between the two groups.

The safety of instrumented outpatient anterior cervical discectomy and fusion

Background context Reported hospitalization times after an anterior cervical discectomy and fusion (ACDF) procedure range between 20 hours to 4 days. Reasons for this wide variation are manifold, but the safety of an instrumented ACDF in the setting of a hostile medical-legal climate is most likely the primary concern influencing such a discrepancy. Purpose The purpose of this study was to evaluate the safety and feasibility of performing single, two- and three-level ACDF with instrumentation on an outpatient or 23-hour observation period basis in order to potentially diminish the additional cost of hardware without compromising the purported benefits of surgery. Study design/setting A retrospective chart review of patients undergoing instrumented ACDF on an outpatient basis was performed. Patient sample A total of 103 patients with neck pain and/or radiculopathy undergoing ACDF were enrolled into this study. Outcome measures Included the evaluation of intraoperative and perioperative complications, which were reported for a total of 6 months after surgery. Clinical examination and radiographical assessment, including plain radiographs and computed tomography and magnetic resonance imaging (when required), were performed to assess complications. Methods Complications were divided into two groups: major and minor. Major complications included vertebral fracture and dehydration resulting in readmission. Minor complications included allergic reactions to medications that did not require hospitalization, and transient (≤3 months) neurologic deficit. A comprehensive literature search and meta-analysis was performed to generate a large comparison group in order to compare the complication rates in our outpatient series to those reported in the literature. Results A total of 99 patients (96.1%) undergoing single and two-level ACDF were discharged less than 15 hours after their surgeries (median time: 8 hours; range: 2–15 hours), and 4 patients (3.9%) were discharged after a 23-hour observation period following three-level ACDF. The overall complication rate in our outpatient series was 3.8% (n=4), including 1.9% (n=2) major and 1.9% (n=2) minor complications. The overall complication rate in the 633 patient meta-analysis derived comparison group was 0.95% (n=6). The difference between overall complication rates was not found to be significantly different (p=.12). The hardware-related complication rate in the meta-analysis comparison group was 0.5% (n=3), and was not found to be significantly different from our rate of 0% (p≤1). Conclusion Performing ACDF with instrumentation on an outpatient basis is feasible, and it is not associated with higher overall or hardware-related complication rates as compared with complication rates reported in the literature, suggesting that this procedure is safe to perform on an outpatient basis.

Traumatic fracture-dislocation of C5 on C6 through a previously solid multilevel anterior cervical discectomy and fusion: a case report and review of the literature

Background context Due to the underlying pathology and altered biomechanics, traumatic cervical fractures have been reported in patients with ankylosing spondylitis (AS), diffuse idiopathic skeletal hyperostosis (DISH), ossification of the posterior longitudinal ligament (OPLL), and combination of DISH and OPLL. However, incidence of a fracture-dislocation through a solid multilevel anterior cervical discectomy and fusion (ACDF) construct with no associated underlying pathology of AS, DISH, or OPLL but severe osteopenia has not, to the best knowledge of the authors, been reported in the medical literature. Purpose To report the development of an unstable cervical spine fracture that occurred through a previous multilevel anterior cervical fusion and the challenges associated with the diagnosis and surgical management of these uncommon lesions. Study design/setting A case report and review of the literature. Methods A case report entailing the clinical history, operative management, and postoperative course of a 72-year-old male patient with no known AS, DISH, or OPLL who suffered a cervical spine fracture-dislocation, secondary to a motor vehicle accident, through a previous solid three-level ACDF that was performed 20 years earlier. Results The patient underwent emergent reduction and realignment of the cervical fracture-dislocation, eventual posterior spinal fusion and stabilization with rigid segmental internal fixation, and application of external halo immobilization. At recent follow-up, he has radiographic evidence of fusion and maintenance of sagittal alignment without loss of reduction. Conclusions Multilevel cervical fusion constructs are susceptible to traumatic injuries. Many of the same challenges in the management of the previously fused ACDF patient, who sustains a fracture-dislocation, are similar to those found in the patient with mass-inflammatory conditions or metabolic disorders, such as AS, DISH, or OPLL. In many cases, this includes severe osteopenia, long unstable fusion segments, and difficulties associated with prolonged halo vest immobilization. As a result, preoperative surgical planning should take into consideration the difficulties in achieving fracture reduction, decompression, and proper stabilization.

Anterior cervical discectomy and fusion involving a polyetheretherketone spacer and bone morphogenetic protein

The authors reviewed clinical and radiographic outcomes in patients who had undergone anterior cervical discectomy and fusion (ACDF) involving the placement of polyetheretherketone (PEEK) spacers filled with recombinant human bone morphogenetic protein (rhBMP)-2. Data obtained in 24 cases were retrospectively evaluated. The follow-up period ranged from 12 to 16 months (mean 13 months). Fifteen patients presented with radiculopathy, eight with myeloradiculopathy, and one with quadriparesis. Single-level ACDF was performed in 12 patients, two-level ACDF in nine, and three-level ACDF in three. Clinical outcomes were assessed using Odom criteria, and fusion was assessed by examining flexion-extension radiographs and computerized tomography scans in cases in which arthrodesis was questionable. Follow-up data were available for 23 patients. One patient died of medical complications unrelated to surgery 4 weeks after ACDF. Clinical outcomes were rated as good/excellent in 22 patients (95%) and fair in one (5%). Solid radiographically documented fusion, with evidence of solid bridging bone and no instability on flexion-extension x-ray films, was present in all cases. Complications included transient recurrent laryngeal nerve injury in one case, transient C-5 paresis in one, cerebrospinal fluid leakage in one, and transient dysphagia in two. Analysis of the results indicated that ACDF involving an rhBMP-2-filled PEEK spacer leads to good clinical outcomes (by Odum criteria) and solid fusion (even in multilevel cases) while avoiding the complications associated with harvesting iliac crest bone grafts.

Comparison of allograft to autograft in multilevelanterior cervical discectomy and fusion with rigid plate fixation

Background context A relatively high pseudarthrosis rate is associated with multilevel anterior cervical discectomy and fusion (ACDF). Anterior plate fixation increases fusion rate in multilevel ACDF. A debate still exists between the effectiveness of allograft versus autograft in plated multilevel ACDF. Purpose To determine the efficacy of allograft versus autograft in fusion rate and clinical outcome in patients undergoing two- and three-level ACDFs with rigid anterior plate fixation. Study design A retrospective radiographic and clinical review to assess fusion, risk factors and clinical outcome of 80 consecutive patients who underwent ACDF with rigid anterior plate fixation involving two and three levels with either allograft or autograft. Patient sample There were 45 patients (56%) who had autogenous iliac crest tricortical grafts and 35 patients (44%) who received tricortical allograft with an average age of 49 years who were treated by multilevel ACDF with rigid anterior plate fixation at a single institution. Thirty-three Peak polyaxial (Depuy-Acromed, Rayham, MA), 26 Orion (Sofamor-Danek, Memphis, TN), 16 Atlantis (Sofamor-Danek, Memphis, TN) and 5 Synthes (Paoli, PA) anterior cervical plating systems were used. All patients underwent ACDF (61 two-level, 19 three-level) by a Smith Robinson technique. All patients had burring of the end plates, 2-mm distraction of the motion segment and graft countersunk 2 mm from the anterior vertebral border. Anterior cervical plate with unicortical screw purchase was used in all cases. Segmental screw fixation was performed in 46 patients. Soft collars were worn postoperatively for 3 to 4 weeks. Outcome measures Follow-up lateral neutral, flexion and extension radiographs were used to assess fusion. The radiographs were reviewed by an independent blinded observer in assessing fusion grades between autograft versus allograft. Clinical outcomes were rated excellent, good, fair and poor based on Odom's criteria. Methods Fusion rate and postoperative clinical outcome were assessed in 80 patients who underwent two- or three-level ACDF with rigid anterior plate fixation. Additional risk factors were also analyzed. Results Radiographic fusion was assessed in all patients (mean, 16 months). Seventy-eight patients (97.5%) achieved solid arthrodesis. Pseudarthrosis occurred in two patients who had allograft for two-level and three-level fusions. Nonsegmental screws were used in the two-level nonunion case. Postoperative dysphagia developed in one two-level nonunion patient, and revision surgery was performed in the other nonunion three-level patient. Twenty-three patients were smokers, and 26 patients had work-related injuries. Clinical outcome (mean, 20 months) was excellent in 23, good in 48 and fair in 9 patients. No statistical significance was noted between demographics, history of tobacco use, graft-type, end plate preparation technique, intermediate segmental screws, plate-type, clinical outcome of fused and nonfused patients and presence of work-related injuries (p > .05). Conclusions A high fusion rate of 97.5% was obtained for multilevel ACDF with rigid plating with either autograft or allograft. In this study, nonunion occurred in patients with allograft but this difference was not statistically significant. Fusion was obtained in 97.8% of patients with segmental screw fixation and 97.1% with nonsegmental screw fixation. Nonsegmental screw fixation may contribute to less than adequate stability and contribute to a higher rate of nonunion, but such effects could not be discerned from this study. Excellent and good clinical outcome was noted in 88.8% of the patients. Proper patient selection and meticulous operative technique is essential to obtain high fusion rates and optimal clinical outcome, which is more important than graft type.