Neurosurgery 97:1153–1161, 2025
This clinical study evaluates fusion rates, fusion timing, and pseudarthrosis risk factors in 119 patients undergoing 2-level versus 3-level anterior cervical discectomy and fusion (ACDF) with minimum two-year follow-up. Fusion was assessed via angular and linear interspinous motion on dynamic radiographs, with Kaplan-Meier and Cox regression analyses.
Key findings show higher and faster fusion in 2-level ACDF; middle levels fuse earliest while caudal levels have lowest rates. Polyetheretherketone (PEEK) cages and multilevel constructs associate with increased pseudarthrosis risk, highlighting material choice and level-specific biomechanics as critical for surgical planning and future research.
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