Significant variability exists in reported fusion rates in the cervical spine after anterior discectomy. Here we review fusion assessment methods, timing of fusion with various intervertebral devices, and examine correlations with clinical outcomes. PubMed, Medline, Embase, Web of Science, Cochrane Library, and Emcare were searched on December 9 2024 for studies involving 1- or 2-level anterior cervical discectomy with quantitative fusion assessment via CT or X-ray. A meta-analysis was conducted using a random-effects model to pool fusion rates and their 95% confidence intervals (CIs) at different follow-up points, for different cage types and different cut-off values evaluating fusion. Sixty-four included studies evaluated 5633 patients. Pooled fusion rates increased over time: 55.6% (95% CI: 43.5%, 67.2%) of patients demonstrated fusion at three months, 74.4% (67.6%, 80.1%) at six months, 88.1% at 12 months (85.1%, 90.6%), and 91.8% (89.1%, 93.9%) at 24 months. Subgroup analysis revealed variation in fusion rates depending on cage type, with titanium cages yielding slightly higher rates at all follow-up times. Sensitivity analysis with fusion criteria showed that a cut-off value < 2 mm for interspinous distance yielded lower fusion rates than the cut-off < 2° for Cobb angle at 6 (70% vs. 77.3%), 12 (83.9% vs. 91.1%) and 24 months (89.5% vs. 91.7%). Results on the correlation between fusion and clinical outcomes were inconsistent. Fusion rates improved over time, approaching 56% at 3 months and 90% at 12 months. Notably, to alleviate heterogeneity across studies, there is a dire need to harmonize reporting guidelines in future research.

Purpose: Cervical Radicular Syndrome is predominantly treated conservatively, but surgical treatment can be considered after shared decision-making. Knowledge about difference in outcome is scarce. The CASINO trial aims to enhance this knowledge to assist patients and physicians in optimizing treatment choices. Methods: A multi-centre observational cohort study was conducted in patients visiting a neurologist or neurosurgeon with CRS and disc-herniation. Conservative and surgical treatment were discussed and in agreement a decision was made. 141 patients with cervical radiculopathy due to intervertebral disc herniations were included, 88 were surgically and 53 were conservatively treated. Visual Analogue Scale for arm pain and Neck Disability Index served as primary outcome parameters. Secondary outcome measures involved VAS neck pain and the EuroQol VAS. Data were collected at baseline, 6, 12, 26, 38, 52 and 104 weeks after inclusion, and analysed using linear mixed-effects models. Results: At baseline, the surgical treatment-arm had more arm pain (VAS Arm Pain, p =.017) but other baseline parameters were comparable. However, during the two years follow up period the surgical arm fared better than the conservatively treated patients: VAS arm pain decreased 12 mm more in the surgical group than in the conservative group (p =.053), exceeding the Minimal Clinical Important Difference (MCID). VAS neck pain decreased 19 mm more in the surgical group than in the conservative group (p =.002), illustrating a significant and clinically relevant difference between the treatment arms. Conclusion: During two years follow up, differences could be substantiated between the two treatment arms regarding arm and neck pain.

The relationship between cervical sagittal balance parameters and clinical outcomes after single-level anterior cervical discectomy and fusion (ACDF) for cervical radiculopathy and/or stenosis remains controversial. This meta-analysis was conducted to assess the evidence. Seven databases were searched through August 2025 for longitudinal studies that reported the correlation between sagittal balance and clinical outcomes. Stratified meta-analyses were conducted for the different sagittal balance parameters and clinical outcomes, accounting for the timing of assessment (preoperative, postoperative, or change scores) using the random-effects models. Seven studies (with 723 patients in total) out of 693 unique studies met the inclusion criteria. A greater Cobbs angle of the target level (lordosis) appeared to be associated with a lower (better) postoperative Neck Disability Index (NDI) (pooled Pearson's r = −0.13, 95% CI: 0.23 to −0.02), while correlations with of C2–C7 angle, cSVA, T1 slope and T1 slope minus C2–C7 lordosis with NDI were not significant. No significant pooled correlations were found between postoperative C2-C7 angle and Visual Analogue Scale (VAS) arm- or neck pain. Non-pooled results demonstrated that a greater pre-operative odontoid incidence was associated with less arm and neck pain (r = −0.27; p = 0.01) and a more favorable NDI (r = −0.24; p = 0.03), and that a higher C2-C7 angle was associated with a more favorable Japanese Orthopaedic Association score (r = 0.40; p = 0.02). A greater postoperative Cobb angle at the target level may improve outcomes after ACDF. Further studies in larger, diverse populations are needed to confirm and generalize the results.

Type D personality, characterized by the combination of negative affectivity and social inhibition, has been associated with adverse outcomes in several patient populations, but its role in patients with cervical radiculopathy remains unknown. This study aimed to evaluate the association between baseline Type D personality and clinical outcomes over a 2 year follow-up period in patients with cervical radiculopathy treated with either conservative or surgical treatment. In addition, we explored baseline characteristics associated with the presence of a Type D personality. Data were derived from the CASINO trial (NTR3504), a prospective multicenter observational cohort study including patients with cervical radiculopathy due to disc herniation. Clinical outcomes included Visual Analog Scale (VAS) arm pain, VAS neck pain, Neck Disability Index (NDI), and EuroQol Visual Analog Scale (EQ-VAS), measured at baseline and during follow-up up to 104 weeks. Linear mixed-effects models were used to evaluate associations between Type D personality and longitudinal clinical outcomes, adjusted for baseline outcome values, age, gender, and BMI. A total of 141 patients were included (mean age 51.1 years; 52% female), of whom 88 (62%) underwent surgical treatment and 40 (28%) had a Type D personality. No significant differences in clinical outcomes were observed during short-term follow-up. Over the 2 year follow-up period, however, in the whole cohort, patients with a Type D personality reported higher VAS arm pain scores compared with patients without a Type D personality (β = 11.72, p = 0.030). Similarly, Type D personality was associated with higher NDI scores at 2 years (β = 7.63, p = 0.033). Furthermore, patients with a Type D personality reported lower EQ-VAS scores at 1 year, reflecting poorer overall perceived health (β = −10.51, p = 0.031). No significant association was observed between Type D personality and VAS neck pain. Baseline characteristics associated with Type D personality included a longer interval between symptom onset and first general practitioner consultation and a higher proportion of patients living alone or not married. Identification of Type D personality may contribute to improved patient counseling and long-term expectation management.

Smoking impairs bone healing and vascularization, which may adversely affect recovery after spinal instrumented spondylodesis surgery. However, the effects of smoking on the clinical outcomes after anterior surgery for cervical radiculopathy remain unclear. (1) Is smoking associated with clinical outcomes after single-level ACDF? (2) Does smoking affect spinal fusion/stability? This retrospective cohort study included 482 patients who underwent single-level ACDF between May 2029 and November 2024, comprising 202 smokers and 208 non-smokers. The Visual Analogue Scale arm and neck pain, pain interference, pain intensity, physical function and the fusion/stability served as outcome measures. Data was collected at baseline, 3-, 6-, 12- and 24 months post-surgery and analysed using linear mixed-effects models. In addition, to evaluate outcomes at the level of individual success, predefined cut-off values were applied (arm pain ≤2.5, neck pain ≤3.5). The presence of spinal fusion was assessed on dynamic radiographs 6- and 12 months post surgery. Baseline characteristics were comparable. Over 24 months, smokers reported 1.65 points higher arm pain (p < 0.001) and 1.56 points higher neck pain (p = 0.003) compared to non-smokers. Moreover, at 24 months, non-smokers achieved higher successful outcomes for arm pain (71.0% vs 52.3%, p = 0.043), but not for neck pain (73.1% vs 60%, p = 0.158). Fusion/stability rates were similar at 6 months (56.1% versus 57.1%, p = 0.943), but after 12 months, non-smokers demonstrated a higher fusion/stability rate (71.7% vs 51.4%, p = 0.006). Non-smokers achieve both better long-term clinical outcomes and higher fusion/stability rates compared to smokers in ACDF surgery.

Anterior Cervical Discectomy and Fusion (ACDF) for cervical radiculopathy is commonly performed with a cage and plate in the United States, whereas in Europe, standalone cages are frequently used instead. Knowledge about difference in clinical outcome is scarce. Are there differences in clinical outcomes in patients undergoing ACDF using a cage with an anterior plate, a cage with integrated screws, or a standalone cage? 570 patients with cervical radiculopathy were included: 414 received a cage with plate (US), 54 received cages with integrated screws (US) and 102 received a standalone cage (86% Netherlands). The clinical outcomes Visual Analogue Scale arm and neck pain, and pain interference were assessed at baseline, 3, 6, 12 and 24 months after inclusion, and analysed using linear mixed-effects models. Furthermore, the Minimal Clinical Important Difference was assessed and to explore individual patient-level outcome, cut-off values for clinical success were utilized. Baseline clinical parameters were comparable in the three groups. Linear mixed-effects models revealed no statistically significant differences in clinical outcome over time. However, dichotomized clinical success rates for neck pain were significantly higher in the standalone group (62.9% at 6 months, 79.3% at 12 months, 85.7% at 24 months), compared to the cage with plate group (59.5%, 61.2%, 58.9%) and the integrated screws group, which showed more variability (58.3%, 26.7%, 44.4%). No substantial differences were observed at the group mean-level, however, the standalone cage group demonstrated higher individual-level success-rates, particularly regarding neck pain.