Outcomes after anterior cervical discectomy and fusion for presumed segmental dysfunction-related neck pain: a Swedish nationwide registry study.
9 affiliations
- 1Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- 2Capio Spine Center Stockholm, Löwenströmska Hospital, Upplands Väsby, Sweden.
- 3Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
- 4Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
- 5Department of Orthopaedics and Hand Surgery, Uppsala University Hospital, Uppsala, Sweden.
- 6Department of Medical Sciences, Örebro University, Örebro, Sweden.
- 7Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. [email protected].
- 8Machine Intelligence in Clinical Neuroscience & Microsurgical Neuroanatomy (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, Zurich, Switzerland. [email protected].
- 9Capio Spine Center Stockholm, Löwenströmska Hospital, Upplands Väsby, Sweden. [email protected].
Abstract
Purpose
Surgical management of mechanically driven neck pain without radiculopathy or myelopathy is a controversial topic, where comparative evidence to non-operative care is limited. This registry-based descriptive cohort study, without a nonoperative comparator, aimed to evaluate longitudinal outcomes after anterior cervical discectomy and fusion (ACDF) for mechanically driven pain presumed to derive from a dysfunctional cervical segment.Methods
This observational cohort included all patients identified in Swespine (2006-2024) who underwent ACDF for presumed segmental dysfunctional-related neck pain and had an available baseline NRS neck pain value, and at least one postoperative NRS neck pain follow-up value. Outcome measures included NRS neck pain, Neck Disability index (NDI), health-related quality-of-life index (EQ5D), and postoperative satisfaction. PROMs were observed at 1, 2, 5, and 10 years postoperatively. Clinically meaningful improvements were defined through established MCID thresholds: ≥ 40% relative reduction in NRS, ≥ 33% relative reduction in NDI, and ≥ 0.08 increase in EQ5D.Results
A total of 36 patients met the inclusion criteria. Mean age was 51 ± 10 years and 50% were males. PROMs at 1-year follow-up revealed MCID achievement in 55% (18/33) for NRS neck pain, 48% (15/31) for NDI, 53% (16/30) for EQ-5D and 64% (21/33) for patient satisfaction following surgery. The improvement of PROMs was predominantly observed at 1 year, with no clear additional improvement thereafter. Patient satisfaction remained consistently high at all time points, ranging from 64-71%.Conclusions
Despite likely substantial selection bias in this group, ACDF was followed by MCID attainment in roughly half of the patients, at one year postoperatively. Patient satisfaction remained relatively high despite heterogeneous PROM trajectories. The results do not support recommendations for surgical treatment in this patient group. Because of the absence of controls, small sample size, and registry-defined diagnosis, causality cannot be inferred. Prospective studies with well-defined, objective, inclusion criteria are warranted to investigate the possible effects of surgical treatment for neck pain alone.
Related
- Short-term outcomes after anterior cervical discectomy and fusion using mJOA and NDI scores in a low- and middle-income country.
- A prospective comparative study of outcomes between zero-profile 3D-printed interbody cages and plate-augmented cages in anterior cervical discectomy and fusion
- Long-Term Risk of Reoperation after Hybrid Cervical Surgery with One-Level Anterior Cervical Corpectomy and Fusion versus Multilevel Anterior Cervical Discectomy and Fusion: A Retrospective Cohort Study
- Visor Flap-Assisted Segmental Mandibulectomy and Immediate Free Fibula Reconstruction for Extensive Plexiform Ameloblastoma of the Anterior Mandible: A Case Report
- Anterior Cervical Discectomy and Fusion Versus Cervical Disc Arthroplasty for Cervical Degenerative Disc Disease: Alarming Rates of Bias.
BibTeX
@article{sameer2026outcomes,
title = {{Outcomes after anterior cervical discectomy and fusion for presumed segmental dysfunction-related neck pain: a Swedish nationwide registry study.}},
author = {Ahmed Haydar Sameer and Zehra Nazar and Victor Gabriel El-Hajj and Erik Edström and Paul Gerdhem and Adrian Elmi-Terander and Victor E Staartjes},
journal = {Acta neurochirurgica},
year = {2026},
month = oct,
doi = {10.1007/s00701-026-07076-y},
url = {https://europepmc.org/article/MED/42911286},
note = {CC BY},
}
RIS
TY - JOUR
TI - Outcomes after anterior cervical discectomy and fusion for presumed segmental dysfunction-related neck pain: a Swedish nationwide registry study.
AU - Ahmed Haydar Sameer
AU - Zehra Nazar
AU - Victor Gabriel El-Hajj
AU - Erik Edström
AU - Paul Gerdhem
AU - Adrian Elmi-Terander
AU - Victor E Staartjes
PY - 2026
DA - 2026/10/22
JO - Acta neurochirurgica
DO - 10.1007/s00701-026-07076-y
UR - https://europepmc.org/article/MED/42911286
AB - Purpose Surgical management of mechanically driven neck pain without radiculopathy or myelopathy is a controversial topic, where comparative evidence to non-operative care is limited. This registry-based descriptive cohort study, without a nonoperative comparator, aimed to evaluate longitudinal outcomes after anterior cervical discectomy and fusion (ACDF) for mechanically driven pain presumed to derive from a dysfunctional cervical segment.Methods This observational cohort included all patients identified in Swespine (2006-2024) who underwent ACDF for presumed segmental dysfunctional-related neck pain and had an available baseline NRS neck pain value, and at least one postoperative NRS neck pain follow-up value. Outcome measures included NRS neck pain, Neck Disability index (NDI), health-related quality-of-life index (EQ5D), and postoperative satisfaction. PROMs were observed at 1, 2, 5, and 10 years postoperatively. Clinically meaningful improvements were defined through established MCID thresholds: ≥ 40% relative reduction in NRS, ≥ 33% relative reduction in NDI, and ≥ 0.08 increase in EQ5D.Results A total of 36 patients met the inclusion criteria. Mean age was 51 ± 10 years and 50% were males. PROMs at 1-year follow-up revealed MCID achievement in 55% (18/33) for NRS neck pain, 48% (15/31) for NDI, 53% (16/30) for EQ-5D and 64% (21/33) for patient satisfaction following surgery. The improvement of PROMs was predominantly observed at 1 year, with no clear additional improvement thereafter. Patient satisfaction remained consistently high at all time points, ranging from 64-71%.Conclusions Despite likely substantial selection bias in this group, ACDF was followed by MCID attainment in roughly half of the patients, at one year postoperatively. Patient satisfaction remained relatively high despite heterogeneous PROM trajectories. The results do not support recommendations for surgical treatment in this patient group. Because of the absence of controls, small sample size, and registry-defined diagnosis, causality cannot be inferred. Prospective studies with well-defined, objective, inclusion criteria are warranted to investigate the possible effects of surgical treatment for neck pain alone.
SN - 0001-6268
SN - 0942-0940
ER -