Purpose of study: To demonstrate the safety and efficacy 3 and 4-level ACDF with stand-alone (no additional anterior fixation) intervertebral cages.

Methods and results: A consecutive cohort of 19 patients undergoing 3 (n=15) and 4-level (n=4) ACDF with Solis cages over 4 years was studied (mean follow-up 24 months). Outcome measures were clinical (VAS scores for neck and arm pain, myelopathy scores) and radiological (disc height, kyphotic angles, fusion).

Neck pain scores improved from 5.1 pre-operatively (range 0–10, s.d. 4) to 2.8 post-operatively (range 0–10, s.d.5), t=3.7, P< 0.0002.

Arm pain scores improved from 5.3 pre-operatively (range 0–10, s.d. 5) to 2.5 post-operatively (range 0–8, s.d. 3), t=2.8, P< 0.009.

Pre-operative myelopathy scores averaged 10.6 (range 7–16, s.d. 4.7) rising to 12.8 post-operatively (range 10–17, s.d. 3.9). Although there was no statistically significant change in myelopathy scores, no patient experienced a worsening of their myelopathy score after surgery.

There were no operative complications. Radiological follow-up demonstrated early improvement in disc space heights (pre-op 3.1 mm, range 1–6 mm; post-op 5.6 mm, range 4–9 mm) but, at 12 months, two patients demonstrated asymptomatic evidence of cage settling and loss of disc height. There was no incidence of pseudarthrosis. No patient has thus far required further surgery.

Conclusion: Multi-level cervical disc disease can be managed safely and effectively by 3 or 4-level discectomy and fusion with stand-alone intervertebral cages.

Ethics approval: None – audit

Interest Statement: None