Anterior Cervical Corpectomy and Fusion Versus Anterior Cervical Discectomy and Fusion for Treatment of Multilevel Cervical Spondylotic Myelopathy: Insights from a National Registry

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) is the most common procedure for single-level cervical spondylotic myelopathy (CSM); however, for multilevel CSM, some patients may also undergo anterior cervical corpectomy and fusion (ACCF). We sought to assess differences in clinical outcomes between patients undergoing ACDF and those undergoing ACCF for multilevel CSM. METHODS: The National Surgical Quality Improvement Program (NSQIP) database was queried from 2007 to 2017 to identify patients diagnosed with CSM undergoing 1- or 2-level ACCF and 2- or 3-level ACDF. Three-to-one propensity scoring was used to match patients undergoing 1-level ACCF to those undergoing 2-level ACDF. Multivariable regression was performed to compare 30-day clinical outcomes between ACCF and ACDF recipients. RESULTS: A total of 3708 patients undergoing 1-level ACCF (n = 729; 18.7%) or 2-level ACDF (n = 3179; 81.3%) were identified. On multivariable regression, 1-level ACCF was associated with significantly longer length of stay (coefficient, 0.79; 95% confidence interval [CI], 0.46-1.11; P < 0.001), longer operative time (coefficient, 19.01; 95% CI, 11.94-26.08; P < 0.001), decreased odds of readmissions (odds ratio [OR], 0.95; 95% CI, 0.91-0.99; P = 0.018), and increased odds of complications (OR, 1.02; 95% CI, 1.00-1.04; P = 0.028) compared with those undergoing 2-level ACDF. A total of 939 patients undergoing either 2-level ACCF (n = 348; 37.1%) or 3-level ACDF (n = 591; 62.9%) were identified. On multivariable regression, 2-level ACCF was associated with significantly longer length of stay (coefficient, 1.17; 95% CI, 0.55-1.79; P < 0.001) and increased risk of complications (OR, 1.05; 95% CI, 1.01-1.08; P = 0.004) compared with 3-level ACDF. - CONCLUSIONS: Our analyses indicate that ACCF may be associated with worse clinical outcomes than ACDF following multilevel treatment for CSM.