Loss of Lordosis at C5-7 Following 2-Level Anterior Cervical Discectomy and Fusion Is Associated With Subsequent Reoperations.

Abstract

Single-center, retrospective cohort study (level III). This study evaluates alignment changes and outcomes after C5-C7 ACDF and examines whether the degree of segmental correction is associated with reoperation. The C5-6 and C6-7 segments are frequently affected in cervical degenerative disc disease due to their mobility and transitional anatomy. Two-level anterior cervical discectomy and fusion (ACDF) is commonly performed at these levels. Although global cervical alignment restoration has been associated with improved functional outcomes and reduced adjacent-segment disease, the specific impact of postoperative lordotic correction at C5-C7 on clinical measures and revision risk remains poorly defined. A retrospective cohort study was conducted at a single institution. Patients undergoing 2-level C5-C7 ACDF were evaluated for demographics, sagittal alignment parameters, and complications through 1 year postoperatively. Multivariate logistic regression, controlling for age, sex, Charlson comorbidity index (CCI), and baseline cervical deformity, was used to assess the association between segmental correction and reoperation. A total of 92 patients underwent C5-C7 ACDF. Mean age was 51.7 years, 57% were female, and mean CCI was 0.5. Significant improvements were observed in C2-C7 lordosis (2.4-7.3 deg.), fused segment alignment (-4.3 to 2.1 deg.), and T1-CL (23.8-20.9 deg.) (all P<0.01). Average correction at fused levels was 6.5 degrees (SD 7.4 deg.). Overall, 12% (11/92) underwent reoperation. Inadequate correction increased reoperation odds 7.2-fold (P=0.028). C5-C7 ACDF yields significant sagittal correction. However, limited segmental improvement may increase reoperation risk. Achieving sufficient correction is important to optimize outcomes and reduce complications.