Equivalent Clinical Outcomes but Divergent Biological Adaptation After Anterior Cervical Discectomy and Fusion Versus Cervical Disc Arthroplasty: A Longitudinal MRI Cohort Study.

Authors

Evren Sönmez, Lokman Ayhan, Said Onar, Ergin Anlı, Abdurrahim Tekin, Engin Can, Selçuk Yapar, Akın Öztürk, Suna Dilbaz, Nuri Serdar Baş, Serdar Çevik

Published in

Journal of clinical medicine. Volume 15. Issue 15. Aug 06, 2026. Epub Aug 06, 2026.

Abstract

Background/Objectives: Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) can produce comparable short-term clinical outcomes, but their regional effects on cervical muscle morphology are incompletely characterized. This study compared 12-month clinical outcomes and quantitative magnetic resonance imaging (MRI) changes after single-level C6-7 ACDF and CDA. Methods: This retrospective longitudinal cohort included 100 age-, sex-, and body mass index-matched patients (50 ACDF and 50 CDA). Neck and arm pain were assessed on 0-10 scales, and the Neck Disability Index (NDI) was analyzed as a 0-50-point score. Regional muscle cross-sectional area (CSA) and fatty infiltration (FI) were quantified on standardized preoperative and 12-month axial T2-weighted turbo spin-echo images at C6-7. The primary analysis included four posterior muscles. CSA change was expressed relative to baseline, whereas FI change was expressed in percentage points. Results: Clinical outcomes were statistically indistinguishable at 12 months (neck-pain score, 0.50 vs. 0.36, p = 0.318; NDI, 2.6 vs. 2.2 points, p = 0.479; perfect-outcome rate, 68.0% in both groups). Both groups showed significant regional posterior muscle CSA reduction and FI increase; however, the magnitude was greater after ACDF than after CDA (CSA reduction, -15% to -19% vs. -5% to -9%; absolute FI increase, +5.1 to +8.2 vs. +1.1 to +2.3 percentage points; all between-group q < 0.001). Surgical technique was independently associated with both MRI change metrics. Greater regional CSA reduction was modestly associated with higher concurrent 12-month neck-pain scores (β = -0.26, p = 0.022). This concurrent association does not establish causation or predict outcomes beyond 12 months. Conclusions: ACDF and CDA produced equivalent measured clinical outcomes at 12 months, while CDA showed a more favorable regional posterior muscle MRI profile. Differential device-related artifact was not quantitatively assessed and cannot be completely excluded, although concordant findings across four implant-remote posterior muscles make artifact unlikely to be the sole explanation. The functional and longer-term clinical significance of this imaging difference is not established and requires prospective longitudinal study.

PMID:
42590218
Bibliographic data and abstract were imported from PubMed on 13 Aug 2026.

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