Four-level ACDF surgical series 2000–2022: a systematic review of clinical and radiological outcomes and complications

The primary objective of this investigation is to systematically scrutinize extant surgical studies delineating Four-Level Anterior Cervical Discectomy and Fusion (4L ACDF), with a specific emphasis on elucidating reported surgical indications, clinical and radiological outcomes, fusion rates, lordosis correction, and the spectrum of complication rates. The literature review was conducted in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, employing the MEDLINE (PubMed), Embase, and Scopus databases. This analysis encompasses studies implementing the 4L ACDF procedure, with detailed extraction of pertinent data pertaining to surgical methodologies, types of employed interbody cages, clinical and radiological endpoints, rates of fusion, and the incidence of complications. Among the 15 studies satisfying inclusion criteria, a marginal increment in the year 2022 (21.4%) was discerned, with a preponderance of study representation emanating from China (35.7%) and the United States (28.6%). 50% of the studies were single-surgeon studies. Concerning follow-up, studies exhibited variability, with 42.9% concentrating on periods of five years or less, and an equivalent proportion extending beyond this timeframe. Across the amalgamated cohort of 2457 patients, males constituted 51.6%, manifesting a mean age range of 52.2–61.3 years. Indications for surgery included radiculopathy (26.9%) and myelopathy (46.9%), with a predilection for involvement at C3–7 (24.9%). Meta-analysis yielded an overall complication rate of 16.258% (CI 95%: 14.823%–17.772%). Dysphagia (4.563%), haematoma (1.525%), hoarseness (0.205%), C5 palsy (0.176%) were the most prevalent complications of 4L ACDF. Fusion rates ranging from 41.3% to 94% were documented. The 4L ACDF is commonly performed to address mylopathy and radiculopathy. While the surgery carries a complication rate of around 16%, its effectiveness in achieving bone fusion can vary considerably.

本研究的核心目的是系统梳理现有针对四节段前路颈椎间盘切除融合术（Four-Level Anterior Cervical Discectomy and Fusion，简称4L ACDF）的外科研究，重点阐明所报道的手术适应证、临床与影像学结局、融合率、颈椎前凸矫正情况及各类并发症发生率。本综述严格遵循系统评价与Meta分析首选报告条目（Preferred Reporting Items for Systematic Reviews and Meta-Analyses，简称PRISMA）指南，检索了MEDLINE（PubMed）、Embase及Scopus数据库。本分析纳入所有实施4L ACDF术式的研究，并详细提取相关数据，包括手术方法、所使用的椎间融合器类型、临床与影像学终点指标、融合率及并发症发生率。在符合纳入标准的15项研究中，2022年发表的研究占比略有提升（21.4%），研究来源以中国（35.7%）与美国（28.6%）为主，其中50%为单术者研究。关于随访时长，各项研究存在差异：42.9%的研究随访时长不超过5年，另有相同比例的研究随访时长超过5年。纳入合并队列的2457例患者中，男性占比51.6%，平均年龄跨度为52.2~61.3岁。手术适应证包括神经根型颈椎病（26.9%）与脊髓型颈椎病（46.9%），病变节段以C3~7最为多见（24.9%）。Meta分析显示总体并发症发生率为16.258%（95%置信区间：14.823%~17.772%）。4L ACDF最常见的并发症为吞咽困难（4.563%）、血肿（1.525%）、声音嘶哑（0.205%）及C5神经根麻痹（0.176%）。研究报道的融合率范围为41.3%~94%。4L ACDF术常用于治疗脊髓型颈椎病与神经根型颈椎病。尽管该手术的并发症发生率约为16%，但其骨融合疗效存在较大差异。