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Related Experiment Video

Updated: Jun 27, 2026

Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
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Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device

Published on: November 8, 2024

Radiological Alignment Trajectories and Late Functional Outcomes After Three-Level ACDF: A Single-Center Cohort

Merdan Orunoglu1, Ukbe Sirayder2, Oguzhan Yilmaz3

  • 1Kayseri State Hospital Neurosurgery Clinic, Kocasinan 38010, Kayseri, Türkiye.

Journal of Clinical Medicine
|June 26, 2026
PubMed
Summary

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Three-level anterior cervical discectomy and fusion (ACDF) impacts cervical alignment differently in sagittal and coronal planes. Poorer sagittal alignment and more adjacent segment degeneration correlate with worse long-term neck disability.

Area of Science:

  • Spine Surgery
  • Orthopedics
  • Radiology

Background:

  • Multilevel cervical degenerative disc disease often requires three-level anterior cervical discectomy and fusion (ACDF).
  • The long-term effects of ACDF on cervical alignment, adjacent segment degeneration (ASD), and patient outcomes require further definition.
  • Understanding these relationships is crucial for optimizing surgical techniques and patient care.

Purpose of the Study:

  • To investigate plane-specific radiological alignment changes after three-level ACDF.
  • To assess the correlation between postoperative alignment, MRI-based ASD, and late patient-reported functional outcomes.
  • To explore potential predictors of long-term disability following ACDF.

Main Methods:

  • Retrospective analysis of 29 patients undergoing three-level ACDF with complete radiographic follow-up.
Keywords:
adjacent segment degenerationcervical alignmentneck disability indexquality of lifethree-level ACDF

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  • Assessment of cervical sagittal and coronal alignment using Cobb angles at multiple postoperative time points (6 months, 1 year, 2 years).
  • Evaluation of ASD on 2-year MRI and correlation with functional outcomes (VAS, NDI, NHP) at a mean follow-up of 42.6 months.

    • Main Results:

    • Significant changes in sagittal Cobb angle over time were observed, while coronal Cobb angle showed a small but significant reduction.
    • Lower sagittal alignment correlated with worse Neck Disability Index (NDI) scores.
    • Greater adjacent disc degeneration (higher Pfirrmann grade) was associated with worse NDI and pain scores.

    Conclusions:

    • Three-level ACDF leads to distinct postoperative trajectories for sagittal and coronal cervical alignment.
    • Reduced sagittal alignment and increased adjacent disc degeneration are linked to poorer late functional outcomes.
    • Findings are hypothesis-generating; larger prospective studies are needed to confirm the independent contributions of sagittal alignment and ASD to long-term outcomes.