Modified Integrated Health State Suggests Lower Cumulative Neck Pain-Related Disability After Cervical Disk...

Anterior cervical diskectomy and fusion (ACDF) and cervical disk replacement (CDR) are common options for cervical degenerative radiculopathy. While previous studies indicate comparable early outcomes at discrete time point, few have quantified cumulative postoperative disability over a year to compare these procedures. To develop novel cumulative postoperative disability and compare the metric between ACDF and CDR.

This is a retrospective study analyzing 327 patients undergoing primary 1- or 2-level ACDF or CDR for degenerative cervical radiculopathy between February 2016 and September 2024 in a single institution. Cumulative postoperative disability was quantified as the modified integrated health status (mIHS), which was area under the curve per week of the 1-year normalized Neck Disability Index modeled using mixed-effects regression. Baseline differences were adjusted using overlap weighting based on propensity scores.

The mIHS demonstrated acceptable construct and modest concurrent validity. The mixed-effects model indicated significantly different recovery trajectories between groups ( P < .001). The mIHS was significantly higher for ACDF than for CDR (3.71 vs 2.68; mean difference, 1.03 [95% CI, 0.80-1.25], P < .001). Level-specific analyses showed that 1-level CDR showed a 21.5% lower mIHS than 1-level ACDF ( P < .001), whereas 2-level CDR had a 32.1% lower mIHS than 2-level ACDF ( P < .001). The 2-level ACDF showed greater mIHS than 1-level ACDF (3.47 vs 3.89; P = .012), whereas 1-level CDR and 2-level CDR were comparable (2.76 vs 2.64; P = .59).

CDR was associated with less cumulative postoperative disability during the first year compared with ACDF. Two-level CDR resulted in disability comparable with 1-level CDR, whereas 2-level ACDF showed greater disability than 1-level ACDF.