A study from April 2026 (1) compared outcomes among patients having three-level ACDF at C3-C6, C4-C7, or C5-T1. Follow-up was at 3, 6, and 12 months, with MCID measured at one year.
Key results:
- The C5-T1 group had more reoperations at two years than the C4-C7 group.
- Although C4-C7 patients started with worse arm pain, they improved more at one year than C3-C6 patients.
- Despite these differences, meaningful clinical improvement (MCID) rates were similar across all groups.
Many patients undergoing anterior cervical discectomy and fusion (ACDF) for degenerative cervical spine disease continue to use pain medications after surgery. A study 2 of 4,366 patients found that before surgery, about 41% used gabapentinoids and opioids. After surgery, around 16% resumed opioid use and 15.6% resumed gabapentinoids. Most patients who used these drugs before surgery stopped afterward, but 2.2% began new, ongoing use of strong opioids. Long-term opioid use is associated with dependence, poorer outcomes, and lower return-to-work rates.
References
1 Lee Y, Herczeg C, K Ng M, Dalton J, Huang R, Baidya J, Olson J, Oris RJ, Narayanan R, Green W, Baek G, Mathew J, Argento I, Lowenstein N, Chua T, Wang N, Giakas A, Kurd MF, Kaye ID, Wilt Z, Canseco JA, Hilibrand AS, Vaccaro AR, Schroeder GD, Kepler CK. The impact of operative level on reoperation rates and short-term patient-reported outcomes in 3-level anterior cervical discectomy and fusion. Eur Spine J. 2026 Apr 10. doi: 10.1007/s00586-026-09917-x. Epub ahead of print. PMID: 41961130.
2 Klimko N, Danner N, Schildt L, Salo H, Leinonen V, Huttunen J. Opioid and Neuropathic Pain Medication use After ACDF for Degenerative Cervical Spine Disease – Nationwide FinSpine Register Study. Spine (Phila Pa 1976). 2026 Apr 9.
