Evidence map›Paper›PMID 42644194›Full record

ArticleJournal of craniovertebral junction & spine

Four-level anterior cervical discectomy and fusion versus posterior cervical fusion: Perioperative outcomes, complications, and sagittal alignment in multilevel cervical pathology.

Dana Saleh, Ahmad Zayd Alkadri, Vito Evola, Atef F Hulliel, Kiana J Yeganeh, Jay Kumar, Alexander Haas, Patrick Kim, Mohsen Rostami, Puya Alikhani

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of craniovertebral junction & spine. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Dana SalehDepartment of Neurosurgery, Brain and Spine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
Ahmad Zayd AlkadriDepartment of Neurosurgery, Brain and Spine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
Vito EvolaDepartment of Neurosurgery, Brain and Spine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
Atef F HullielDepartment of Neurosurgery, Brain and Spine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
Kiana J YeganehDepartment of Neurosurgery, Brain and Spine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
Jay KumarDepartment of Neurosurgery, Brain and Spine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
Alexander HaasDepartment of Neurosurgery, Brain and Spine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
Patrick KimDepartment of Neurosurgery, Brain and Spine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
Mohsen RostamiDepartment of Neurosurgery, Brain and Spine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
Puya AlikhaniDepartment of Neurosurgery, Brain and Spine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Four-level cervical fusion is uncommon for extensive degenerative cervical spondylotic myelopathy or multilevel stenosis, with anterior cervical discectomy and fusion (ACDF) and posterior cervical fusion (PCF) representing the primary approaches. Direct comparisons of four-level constructs are limited, particularly regarding perioperative outcomes, complications, hardware durability, and sagittal alignment. Methods: Retrospective review of 64 consecutive patients (34 ACDF, 30 PCF) undergoing primary four-level cervical fusion at a single institution (2011-2024) with a minimum 1-year follow-up (mean ~ 44 months). Groups were comparable in demographics, comorbidities, and primary diagnosis (96.9% stenosis ± myelopathy). Outcomes included perioperative metrics, complications, hardware failure, revision rates, and sagittal parameters. Results: ACDF demonstrated significantly longer operative time (285 vs. 200 min, Conclusion: Four-level ACDF offers perioperative efficiency with shorter hospital length of stay but is associated with higher rates of dysphagia, hoarseness, and hardware failure compared to PCF. In contrast, PCF provides greater hardware durability. Approach selection should be individualized based on pathology location, sagittal goals, and patient risk profile. Prospective studies with functional outcomes are needed to optimize the management of four-level cervical reconstruction.

Indexed as

Anterior cervical discectomy and fusiondysphagiahardware failuremultilevel cervical myelopathyposterior cervical fusionsagittal alignment

Identifiers

PMID42644194
PMCPMC13506109

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.