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Restoration of Cervical Alignment is Associated with Improved Clinical Outcome after One and Two Level Anterior Cervical Discectomy and Fusion

Xiaobang Hu, MD, PhD,1 Donna D. Ohnmeiss, Dr med,2 Jack E. Zigler, MD,3 Richard D. Guyer, MD,3 Isador H. Lieberman, MD, FRCSC, MBA1

1Scoliosis and Spine Tumor Program, Texas Back Institute, Texas Health Presbyterian Hospital Plano, Plano, TX, 2Texas Back Institute Research Foundation, Plano, TX, 3Texas Back Institute, Plano, TX



Anterior cervical discectomy and fusion (ACDF) remains the standard of care for patients with cervical radiculopathy who are unresponsive to conservative care. However, the maintenance and restoration of cervical alignment as a predictive factor for outcome has not yet been fully evaluated. The purpose of this study was to evaluate the impact of maintaining or restoring cervical alignment on one and two level ACDF patients’ outcome.


Data were collected from 104 patients who underwent one and two level ACDF. Cervical alignment was measured preoperatively and at follow-up visits. The patients were classified into three groups based on the postoperative change of their cervical alignment. Neck pain, arm pain, and Neck Disability Index (NDI) scores were obtained preoperatively and at the latest follow-up visit. Incidences of adjacent segment degeneration (ASD) and reoperations because of ASD were recorded.


There were 64 patients in the Maintained group, 17 patients in the Restored group and 23 patients in the Kyphotic group. Pre-operatively, the neck pain scores, arm pain scores and NDI scores were not statistically different among the three groups (p>0.05). On average at 12 months follow-up, the neck pain scores improved by 2.7, 4.2, and 2.7 points respectively in the three groups (p>0.05). The patients’ arm pain scores improved by 2.1, 2.4, and 2.8 points respectively (p>0.05). NDI scores improved by 12, 31 and 13.7 points respectively (p<0.05). The incidences of ASD and reoperations because of ASD were 16%, 12% and 35% respectively (p>0.05).


The patients with restored cervical alignment had significantly greater NDI improvement and relatively better neck pain improvement. There was a trend for patients who had unchanged cervical kyphosis to have a higher incidence of ASD. Our study suggests that restoration of cervical alignment will contribute to improved clinical outcome in the patients who have one and two level ACDF surgeries.

Level of Evidence 

This is a level III study.

Anterior cervical discectomy and fusion, cervical alignment, lordosis, adjacent segment degeneration, clinical outcome
Volume 9 Article 61