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. 2025 Nov 28.
doi: 10.1097/BRS.0000000000005582. Online ahead of print.

Recovery Trajectories After Anterior Cervical Discectomy and Fusion

Tomoyuki Asada  1 , Eric Zhao, Adin M Ehrlich, Sereen Halayqeh, Adrian Lui, Kasra Araghi, Olivia Tuma, Andrea Pezzi, Tarek Harhash, Sophie Kush, Courtney Harris, Amy Lu, Harvinder S Sandhu, Todd J Albert, Han Jo Kim, James C Farmer, Russel C Huang, Matthew Cunningham, Francis C Lovecchio, Kyle Morse, James E Dowdell, Evan D Sheha, Sheeraz A Qureshi, Sravisht Iyer
Affiliations

Recovery Trajectories After Anterior Cervical Discectomy and Fusion

Tomoyuki Asada et al. Spine (Phila Pa 1976). .

Abstract

Study design: Retrospective analysis.

Objective: To characterize recovery trajectory after anterior cervical discectomy and fusion (ACDF) by identifying recovery phases and their inflection timepoints.

Summary of background context: Understanding how the number of fused levels influences recovery is essential for tailoring surgical decisions and postoperative management.

Materials and methods: This study included patients who underwent primary ACDF for degenerative cervical disease. Outcome measures included the Neck Disability Index (NDI), and numeric rating scale (NRS) for neck and arm pain, collected longitudinally. Segmented regression modeling was employed to predict recovery trajectories by phase-specific slopes, and inflection timepoints between phases.

Results: A total of 290 patients were included. Segmented regression identified three improvement phases of NDI: early improvement phase (EIP), late improvement phase (LIP), and plateau phase (PP), with two inflection timepoints between phases (EIP to LIP: day 43.4±6.7; LIP to PP: day 100.7±13.1). During EIP, the 1-level group demonstrated significantly steeper improvement slopes (-0.44 points/day in NDI) compared to ≥2-level (-0.35 points/day; P=0.001). The models for NRS for neck and arm pain detected two phases: the improvement phase and PP. Neck pain improved until day 24.1±2.6, while arm pain improved until day 10.6±2.0. Level specific model showed that the breakpoint for NRS neck occurred faster in 1-level compared to ≥2-level (18.0 ± 3.0 vs. 28.2 ± 4.0 d; P = 0.042).

Conclusion: The recovery trajectory of disability following ACDF was characterized by three phases: rapid improvement until 4-6 weeks, slower improvement until 3-4 months, followed by symptom plateau after 4 months. A greater number of fused levels slows early disability recovery and delays neck‑pain relief. These findings are informative to tailor peri‑operative expectations and rehabilitation protocols to fusion length.

Level of evidence: 3.

Keywords: Recovery trajectory; anterior cervical discectomy and fusion; mixed-effects regression model; segmented regression; symptomatic improvement.

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Conflict of interest statement

Conflict of Interest Statement: Harvinder S. Sandhu or may receive payments or benefits from the following commercial entities: Seaspine (Consultant); BioRestorative Therapies (Consultant); Prosidyan (Consultant, Ownership/Equity/Investment); Spine Wave, Inc. (Inventor, Ownership/Equity/Investment); Providence Medical Technology, Inc. (Ownership/Equity/Investment); HS2, LLC (Ownership/Equity/Investment); Paradigm Spine, LLC (Ownership/Equity/Investment). Todd J. Albert has or may receive payments or benefits from the following commercial entities: Augmedics and Pulse Equity (Ownership Interest in any medical device distributor, manufacturer, surgery center or group-purchasing organization); Back Story LLC, InVivo Therapeutics, Spinicity, CytoDyn Inc., Paradigm Spine, LLC, HS2, LLC, Parvizi Surgical Innovation, LLC, Surg.IO LLC, Care Equity, Morphogenesis, Precision Orthopedics, and Physician Recommended Nutriceuticals (Ownership/Equity/Investment); BIOMET (Now ZIMMER BIOMET) and DePuy Synthes Spine (Royalties from Intellectual Property). Han Jo Kim has or may receive payments or benefits from the following commercial entities: ZIMMER BIOMET (Consultant, Royalties from Intellectual Property); Vivex Biologics, NuVasive, Inc., and Aspen Medical Products (Medical or Scientific Advisory Board Membership); HS2, LLC and SPINE STUD (Ownership/Equity/Investment); International Spine Society Group (ISSG) (Research Support either personally or through HSS); Acuity Surgical and K2 Medical, LLC (Royalties from Intellectual Property); K2 Medical, LLC (Speakers’ Bureau). The author also serves on the Board of Directors of the Manhattan School of Music and FOCOS Hospital. James C. Farmer has or may receive payments or benefits from HS2, LLC (Ownership/Equity/Investment). One or more of the authors (MC) has or may receive payments or benefits from the following commercial entities: Radius Health Inc. (Research Support either personally or through HSS); Better PT (Inventor [familial interest], Board of Directors/Trustees/Governors/Managers, Member at Large or Committee member [familial]); Sustain Surgical (Ownership Interest). Sheeraz A. Qureshi has or may receive payments or benefits from the following commercial entities: Tissue Differentiation Intelligence (Ownership/Equity/Investment); Stryker K2M (Royalties from Intellectual Property, Designer, Consultant); SpineGuard, Inc. (Consultant); Globus Medical, Inc. (Royalties from Intellectual Property, Speakers’ Bureau, Consultant); Simplify Medical, Inc. (Clinical Event Committee); AMOpportunities (Honoraria); Surgalign (Consultant); Viseon, Inc. (Research Support either personally or through HSS, Consultant); HS2, LLC (Ownership/Equity/Investment); LifeLink.com Inc. and Spinal Simplicity, LLC (Medical or Scientific Advisory Board Membership). The author also serves in editorial or leadership roles at: Contemporary Spine Surgery (Editorial Board); North American Spine Society (NASS) (Political Engagement Committee, Payor Policy Review Committee, SpinePAC Advisory Committee, CME Committee); Annals of Translational Medicine (ATM) (Editorial Board); Hospital for Special Surgery Journal (Editorial Board, Senior Associate Editor, 2021–2024); Society of Minimally Invasive Spine Surgery (SMISS) (Program Committee, 2018 Annual Meeting Program Chair, Board of Directors, 2021–2024); Lumbar Spine Research Society (LSRS) (Website Committee, 2022, Member at Large); Cervical Spine Research Society (CSRS) (Publications Committee, 2019–2022); Minimally Invasive Spine Study Group (Board of Directors – Treasurer); Association of Bone and Joint Surgeons (ABJS) (Program Committee); and International Society for the Advancement of Spine Surgery (ISASS) (Education and Program Committees, 2021 Annual Meeting Program Chair). Sravisht Iyer has or may receive payments or benefits from the following commercial entities: Globus Medical and Stryker (Paid presenter or speaker); Vertebral Columns/International Society for the Advancement of Spine Surgery (ISASS) (Editorial or Governing Board). Other authors certify that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members.

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