Clinical Outcomes Following Three- and Four-Level Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis
Abstract
Study Design/Setting Systematic review and meta-analysis. Objectives Anterior cervical discectomy and fusion (ACDF) is a well-established treatment for degenerative cervical pathology. Although outcomes following 1- and 2-level ACDF are favorable, increasing construct length has been associated with worse outcomes. Despite this, 3- and 4-level ACDF are often grouped as “multilevel” constructs, though emerging evidence suggests 4-level ACDF may carry greater risk. This study systematically reviewed the literature and performed a meta-analysis comparing outcomes between 3- and 4-level ACDF. Methods A systematic search of MEDLINE, Embase, and Cochrane databases was performed per PRISMA guidelines. Studies reporting outcomes following three- or four-level ACDF were included. Complex etiology and registry-based studies were excluded. Analysis included patient-reported outcomes, perioperative characteristics, and postoperative fusion and complication rates. Data were synthesized, and random-effects meta-analysis was performed using Cohen’s d for continuous outcomes and log odds ratios for dichotomous outcomes. Results Both 3- and 4-level ACDF improved pain, disability, and neurologic function. Meta-analysis showed 4-level ACDF had less improvement in axial neck pain, with similar arm pain improvement. Fusion rates were lower with 4-level ACDF. Perioperative outcomes favored 3-level constructs, with 4-level ACDF associated with longer operative time, greater blood loss, and longer…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
Read the paper
Related studies
- Characterization and Analysis of Porosity and Pore Structures
- Practical considerations for conducting ecotoxicity test methods with manufactured nanomaterials: what have we learnt so far?
- Dental Optical Coherence Tomography
- Radiation-shielding concrete: A review of materials, performance, and the impact of radiation on concrete properties
- Testing entanglement of annihilation photons
- Calanus finmarchicus seasonal cycle and diapause in relation to gene expression, physiology, and endogenous clocks
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.