LAUSR

INTRODUCTION Anterior cervical discectomy and fusion (ACDF) is the most common procedure for single level cervical spondylotic myelopathy (CSM); however, for multi-level 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 ACCF for multi-level CSM. METHODS The National Surgical Quality Improvement Program (NSQIP) database was queried from 2007-2017 to identify patients diagnosed with CSM undergoing 1- or 2-level ACCF and 2- or 3-level ACDF. Three-to-one propensity scoring was employed to match patients undergoing 1-level ACCF to 2-level ACDF. Multivariable regression was performed to compare 30-day clinical outcomes between ACCF and ACDF. 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 as compared to 2-level ACDF was significantly associated with increased length of stay (LOS) (Coef. 0.79; 95%CI 0.46-1.11; p-value <0.001), longer operative-time (Coef. 19.01; 95%CI 11.94-26.08; p-value <0.001), decreased odds of readmissions (OR 0.95; 95%CI: 0.91-0.99; p-value 0.018), and increased odds of complications (OR 1.02; 95%CI 1.00-1.04; p-value 0.028). 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 as compared to 3-level ACDF was significantly associated with longer LOS (Coef. 1.17; 95%CI 0.55-1.79; p-value <0.001) and increased odds of complications (OR 1.05; 95%CI 1.01-1.08; p-value 0.004). CONCLUSION Our analyses indicate that ACCF may be associated with worse clinical outcomes following multilevel treatment for CSM.