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Recovery Trajectories After Anterior Cervical Discectomy and Fusion.

Tomoyuki Asada1, Eric Zhao, Adin M Ehrlich

  • 1Hospital for Special Surgery, 535 E 70th St, New York, NY, USA.

Spine
|December 2, 2025
PubMed
Summary

Anterior cervical discectomy and fusion (ACDF) recovery involves three phases: rapid improvement, slower improvement, and plateau. More fused levels delay recovery and neck pain relief.

Keywords:
Recovery trajectoryanterior cervical discectomy and fusionmixed-effects regression modelsegmented regressionsymptomatic improvement

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Area of Science:

  • Spine surgery outcomes
  • Degenerative cervical spine disease

Background:

  • Understanding recovery after anterior cervical discectomy and fusion (ACDF) is crucial for patient management.
  • The influence of the number of fused levels on recovery is not well-defined.

Purpose of the Study:

  • To characterize the recovery trajectory after ACDF.
  • To identify distinct recovery phases and their inflection timepoints.
  • To assess the impact of the number of fused levels on recovery.

Main Methods:

  • Retrospective analysis of 290 patients undergoing primary ACDF for degenerative cervical disease.
  • Longitudinal collection of Neck Disability Index (NDI) and numeric rating scale (NRS) for neck and arm pain.
  • Segmented regression modeling to identify recovery phases, slopes, and inflection timepoints.

Main Results:

  • Three NDI improvement phases identified: early (43.4 days), late (100.7 days), and plateau.
  • One-level fusions showed steeper early NDI improvement compared to ≥2-level fusions.
  • Neck pain improved until ~24 days, arm pain until ~11 days; one-level fusions had faster neck pain relief.

Conclusions:

  • ACDF recovery follows three phases: rapid (0-6 weeks), slower (6 weeks-4 months), and plateau (>4 months).
  • Increased fusion levels impede early disability recovery and delay neck pain resolution.
  • Findings inform patient expectations and rehabilitation protocols based on fusion length.