ABSTRACT
Decompression for multilevel degenerative, traumatic, neoplastic, or infectious disease of the cervical spine can be achieved via several approaches, including laminectomy, laminoplasty, segmental anterior cervical discectomy, and fusion (ACDF), or anterior corpectomy and fusion (ACF) (1-3). Although, laminectomy and laminoplasty are associated with less perioperative morbidity and have been found to be effective for the treatment of multilevel cervical myelopathy (4), the potential for progressive cervical kyphosis and axial neck pain are two significant disadvantages of these procedures (5,6). In addition, neither allows for adequate spinal cord decompression in cases of significant anterior compressive lesions. Segmental ACDF does allow for decompression of the anterior cervical spinal canal. Nevertheless, although singlelevel ACDF has been shown to be a very efficacious procedure with successful decompression and fusion occurring in up to 94% of patients (7,8), multilevel ACDF has been associated with nonunion rates as high as 53% (9,10). As successful arthrodesis has been correlated with improved clinical outcomes (11-13), multilevel ACDF may lead to unacceptably high rates of recurrent pain and/or neurological symptoms for patients with pathology of multiple levels of the anterior cervical spine.
