Outcomes after anterior cervical discectomy and fusion for presumed segmental dysfunction-related neck pain: a Swedish nationwide registry study

Abstract Purpose Surgical management of mechanically driven neck pain without radiculopathy or myelopathy is a controversial topic, where comparative evidence to non-operative care is limited. This registry-based descriptive cohort study, without a nonoperative comparator, aimed to evaluate longitudinal outcomes after anterior cervical discectomy and fusion (ACDF) for mechanically driven pain presumed to derive from a dysfunctional cervical segment. Methods This observational cohort included all patients identified in Swespine (2006–2024) who underwent ACDF for presumed segmental dysfunctional-related neck pain and had an available baseline NRS neck pain value, and at least one postoperative NRS neck pain follow-up value. Outcome measures included NRS neck pain, Neck Disability index (NDI), health-related quality-of-life index (EQ5D), and postoperative satisfaction. PROMs were observed at 1, 2, 5, and 10 years postoperatively. Clinically meaningful improvements were defined through established MCID thresholds: ≥ 40% relative reduction in NRS, ≥ 33% relative reduction in NDI, and ≥ 0.08 increase in EQ5D. Results A total of 36 patients met the inclusion criteria. Mean age was 51 ± 10 years and 50% were males. PROMs at 1-year follow-up revealed MCID achievement in 55% (18/33) for NRS neck pain, 48% (15/31) for NDI, 53% (16/30) for EQ-5D and 64% (21/33) for patient satisfaction following surgery. The improvement of PROMs was predominantly observed at 1 year, with no clear additional improvement thereafter. Patient satisfaction remained consistently high at all time points, ranging from 64–71%. Conclusions Despite likely substantial selection bias in this group, ACDF was followed by MCID attainment in roughly half of the patients, at one year postoperatively. Patient satisfaction remained relatively high despite heterogeneous PROM trajectories. The results do not support recommendations for surgical treatment in this patient group. Because of the absence of controls, small sample size, and registry-defined diagnosis, causality cannot be inferred. Prospective studies with well-defined, objective, inclusion criteria are warranted to investigate the possible effects of surgical treatment for neck pain alone.