Anterior cervical decompression and fusion for neck pain in the patients with cervical spondylosis: pooled results of three prospective cohort studies

Currently, there is a lack of large-scale prospective cohort data to explore the response of neck pain to anterior cervical decompression and fusion (ACDF). The aim of this study was to investigate whether patients with neck pain can achieve consistent neck pain relief following ACDF regardless of preoperative neurological symptoms and number of surgical segments. The study was a pooled analysis of 3 multicenter prospective cohort studies. Patients with cervical radiculopathy and/or myelopathy with significant neck pain (visual analog scale [VAS] ≥ 4) who underwent ACDF were included. Neck pain VAS scores (VAS-neck) were collected at preoperative and postoperative follow-up time points (3 months, 6 months, and 1 year). Subgroup analyses were conducted for patients with radiculopathy, myelopathy, or myeloradiculopathy, as well as for single- versus multi-segment ACDF. A total of 237 patients were confirmed. Patients showed significant improvement in VAS-neck at all follow-up time points compared with baseline (P < 0.001 for each). In the first year after surgery, VAS-neck were reduced by 3.3 points (57.0%) on average, and the rates of achieving minimum clinically important difference and patient acceptable symptom state were 72.2% and 73.8%, respectively. Meanwhile, one year after surgery, there was no significant difference in ΔVAS-neck, recovery rate, minimum clinically important difference, and patient acceptable symptom state attainment rate between the radiculopathy, myelopathy and myeloradiculopathy groups, and the same trend was observed between the single-segment and multi-segment groups. This study found that ACDF significantly improved neck pain in patients with cervical spondylosis, regardless of preoperative neurological symptoms and number of surgical segments.