Comparison of Clinical Outcomes Between ACDF and CDR for Predominant Neck Pain Using IPTW

Introduction: Patients with cervical radiculopathy often experience arm pain, but many also report significant neck pain. Traditionally, anterior cervical discectomy and fusion (ACDF) has been preferred for alleviating neck pain, while cervical disc replacement (CDR) has been viewed as less effective, especially in patients with severe neck pain due to concerns about preserving mobility in the symptomatic segment. Recent studies, however, have shown promising outcomes for CDR, particularly in patients with arm pain, but no direct comparison in patients with predominant neck pain has been conducted. This study compares clinical outcomes between ACDF and CDR in patients with predominant neck pain using inverse probability of treatment weighting (IPTW) to adjust for baseline differences.

Methods: This retrospective study included 179 patients with predominant neck pain (VAS neck pain ≥ VAS arm pain and NDI > 20) who underwent either ACDF (n = 105) or CDR (n = 74) for cervical radiculopathy between 2017 and 2023. Preoperative and 1-year postoperative patient-reported outcomes (PROs) were assessed, including the Neck Disability Index (NDI) and Visual Analogue Scale (VAS) for neck pain. To reduce the effects of confounding variables, IPTW was applied to balance the baseline characteristics between the two groups. Linear mixed-effect models were used to analyze postoperative outcomes.

Results: Both ACDF and CDR resulted in significant improvements in NDI and VAS neck scores at 1 year compared to baseline (NDI: β = -1.81, P < 0.001; VAS neck: β = -0.26, P < 0.001). After IPTW adjustment, no significant differences were observed between the two groups in terms of NDI (β = -0.44, P = 0.09) or VAS neck scores (β = -0.07, P = 0.10) at 1 year. Other PROs also demonstrated no significant differences between the groups.

Conclusion : ACDF and CDR both effectively alleviate neck pain in patients with predominant neck pain and cervical radiculopathy. Despite earlier concerns regarding CDR’s efficacy for neck pain, this study shows that CDR achieves outcomes comparable to ACDF. CDR should be considered a viable alternative in patients where motion preservation is desired, even in cases of significant preoperative neck pain.