Journal of spine surgery (Hong Kong) · 2026
Retrospective cohort study of recovery trajectories following anterior versus posterior fusion surgery for cervical degenerative pathology.
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Lee K, Pamula A, Tang A, Chen T
Аннотация
BACKGROUND: Anterior cervical discectomy and fusion (ACDF) and posterior decompression and instrumented fusion (PDIF) are two common spinal procedures for treating cervical degenerative pathology. While previous studies have compared outcomes and complication profiles between ACDF and PDIF, there is limited outcomes data investigating the rates and patterns of clinical improvement of the two techniques. The purpose of this study was to (I) compare trends in patient reported neck disability index (NDI) scores perioperatively between ACDF and PDIF; (II) identify demographic and perioperative characteristics that may influence rate of improvement; and (III) compare surgical intraoperative complications and reoperation rates.
METHODS: A retrospective review from 2019-2023 was performed identifying 309 consecutive patients undergoing primary or revision ACDF (n=271) or PDIF (n=38) for degenerative disease. A minimal clinically important difference (MCID) of 11 was assumed based on previous literature.
RESULTS: Average follow-up was 2.2 years. ACDF patients were younger (56.1 vs. 60.4 years, P=0.02), had more primary surgeries (99% vs. 74%, P<0.001) for radiculopathy (67% vs. 35%, P<0.001), less blood loss (34.9 vs. 128.2 mL, P<0.001), and shorter hospital stays (2.0 vs. 2.9 days, P=0.001). There was no difference in intraoperative complication or revision rates. ACDF patients had lower NDI scores at all timepoints (P<0.001) and greater delta improvement at final follow-up (-24.1±16.9 vs. -15.9±17.7, P=0.006). MCID achievement rates for ACDF vs. PDIF were: 3 months (72% vs. 46%, P=0.004), 6 months (76% vs. 50%, P=0.005), and 1 year (78% vs. 61%, P=0.04). There was similar MCID improvement between radiculopathy, myelopathy, and myeloradiculopathy diagnoses and single vs. multilevel fusion at all timepoints (P>0.05). No demographic or perioperative factors influenced NDI improvement.
CONCLUSIONS: Both ACDF and PDIF achieve long-term improvement exceeding MCID with similar rates. ACDF patients demonstrated faster recovery and higher MCID achievement rates at 1-year. Clinical improvement was comparable across diagnoses and number of fusion levels. These findings provide guidance in preoperative counseling, establishing realistic recovery timelines, and managing postoperative expectations.
METHODS: A retrospective review from 2019-2023 was performed identifying 309 consecutive patients undergoing primary or revision ACDF (n=271) or PDIF (n=38) for degenerative disease. A minimal clinically important difference (MCID) of 11 was assumed based on previous literature.
RESULTS: Average follow-up was 2.2 years. ACDF patients were younger (56.1 vs. 60.4 years, P=0.02), had more primary surgeries (99% vs. 74%, P<0.001) for radiculopathy (67% vs. 35%, P<0.001), less blood loss (34.9 vs. 128.2 mL, P<0.001), and shorter hospital stays (2.0 vs. 2.9 days, P=0.001). There was no difference in intraoperative complication or revision rates. ACDF patients had lower NDI scores at all timepoints (P<0.001) and greater delta improvement at final follow-up (-24.1±16.9 vs. -15.9±17.7, P=0.006). MCID achievement rates for ACDF vs. PDIF were: 3 months (72% vs. 46%, P=0.004), 6 months (76% vs. 50%, P=0.005), and 1 year (78% vs. 61%, P=0.04). There was similar MCID improvement between radiculopathy, myelopathy, and myeloradiculopathy diagnoses and single vs. multilevel fusion at all timepoints (P>0.05). No demographic or perioperative factors influenced NDI improvement.
CONCLUSIONS: Both ACDF and PDIF achieve long-term improvement exceeding MCID with similar rates. ACDF patients demonstrated faster recovery and higher MCID achievement rates at 1-year. Clinical improvement was comparable across diagnoses and number of fusion levels. These findings provide guidance in preoperative counseling, establishing realistic recovery timelines, and managing postoperative expectations.