Efficiency of Horizontal Skin Incision at 1-Level And 2-Level Anterior Cervical Discectomy and Fusion: A Prospective Observational Study

Abstract

Objective:  Horizontal skin incision is an optimal treatment approach in Anterior Cervical Discectomy and Fusion (ACDF). However, evidence comparing the efficiency of these incisions in 1-level and 2-level ACDF remained uncertain. The study aimed to assess and compare efficiency, clinical and cosmetic outcomes, along with patient and clinician satisfaction, and complications associated with horizontal skin incision in 1-level and 2-level ACDF procedures.

Methods:  A prospective observational study recruiting 453 participants who underwent ACDF via horizontal skin incision was conducted between February 2023 to January 2024. Participants were divided into 1-level (n=256) and 2-level (n=188) ACDF groups. Operative parameters, cosmetic outcomes (POSAS, VSS), and postoperative complications were assessed. A follow-up at 3, 6, and 12 months was held. SPSS software v.26 was employed for data analysis, and a p-value of <0.05 was considered significant.

Results:  The 2-level ACDF group showed significantly longer incision length, surgical duration, and hospitalization (p<0.001). The 1-level ACDF exhibited superior results regarding scar visibility, symmetry, and patient satisfaction at each follow-up (p<0.05). Mean PSOAS and VSS scores were also significantly lower (better) in the 1-level group, indicating better cosmetic outcomes. Complications, including dysphagia and dysphonia, were significantly more prevalent in the 2-level ACDF group (p<0.05), while wound-related complications were comparable across both groups (p>0.05).

Conclusion:  The horizontal (transverse) skin incision provided favorable outcomes across both groups. However, 1-level ACDF was associated with greater efficiency, minimal complications, and a higher satisfaction level among patients. Additionally, multiple-level ACDF has an increased risk of postoperative complications and blood loss.