LAUSR

OBJECTIVE There are limited patient-reported outcome measure (PROM) data on 4- and 5-level ACDF. The largest series to date solely focused on complications. This retrospective series evaluates PROMs after 4- and 5-level ACDF. METHODS Pertinent data from adult patients treated with a 4- or 5-level ACDF in 2011-2019 were analyzed. PROMs and minimal clinically important differences (MCID) were assessed. Factors associated with favorable and unfavorable outcomes were identified. RESULTS There were thirty-four patients (thirty underwent 4-level and four underwent 5-level ACDFs) with mean age of 59.6; 55.9% were women. At 3 months, there were significant improvements in PROMs except SF-12 MCS with modest improvement. At 12 months, there were significant improvements in PROMs except SF-12 PCS with moderate improvement. The proportions of patients that met the MCID cut-offs ranged from 35.3% (NRS-neck) to 75% (VR-12 PCS) at 3 months and 38.2% (NRS-arm) to 65.5% (VR-12 MCS) at 12 months. Shorter symptom duration was associated with significantly reduced postoperative pain and NDI scores. Shorter length of stay was associated with significantly improved postoperative functional outcomes. 4-level compared 5-level ACDF patients achieved better postoperative PROMs. Shorter procedure duration was associated with improved PROMs at 3 months. No patients returned to the operating room within 30 days. Patients that required reoperation achieved significantly inferior NDI, NRS-neck, and SF-12 PCS at 3 months. CONCLUSIONS This study demonstrated satisfactory PROMs up to 12 months after 4- and 5-level ACDF despite the complication rate. With thorough preoperative planning and meticulous technique, performing this procedure in carefully selected patients may be associated with acceptable PROM.