Temporal Trends of Recovery in Patients With Radiculopathy-Only Versus Myelopathy Following Single- and Multilevel ACDF

Study Design: Retrospective cohort study. Objective: To compare improvement trends and recovery kinetics between patients with radiculopathy-only versus myelopathy/myeloradiculopathy after anterior cervical discectomy and fusion (ACDF). Summary of Background Data: Patients with radiculopathy-only may experience different recovery rates compared with patients with myelopathy following ACDF. No studies currently exist that analyze differences in recovery rates between these cohorts following single- and multilevel ACDF. Methods: Patients who underwent primary single- or multilevel ACDF with a minimum of 1-year follow-up were included. Outcomes included: patient-reported outcome measures (PROMs), such as neck disability index (NDI), 12-Item Short Form Survey Physical Component Score (SF12 PCS), and visual analog scale (VAS) for neck and arm; PROMs minimal clinically important difference (MCID); global rating of change (GRC); and return to activities. Time points included preoperative and postoperative 2 weeks, 6 weeks, 12 weeks, 6 months, 1 year, and 2 years. Results: A total of 616 patients were included (232 radiculopathy-only; 384 myelopathy). VAS neck and arm improvements typically plateaued within 6 weeks for both cohorts, for single- and multilevel ACDF. NDI and SF12 PCS improvements typically plateaued within 12 weeks to 6 months. Plateaus tended to occur later in the myelopathy cohort, especially for VAS neck and SF12 PCS. Percent PROMs MCID achievement tended to peak at 1 year, especially for multilevel ACDF. The radiculopathy-only cohort experienced greater improvement on GRC at 12 weeks and 1 year for single-level ACDF, with no differences between cohorts in multilevel ACDF. Patients returned to activities within 2 to 6 weeks, with multilevel ACDF patients returning more slowly. Conclusion: After ACDF, pain improvements typically plateau within 6 weeks, while functionality can continue to improve through 6 months. Patients with myelopathy tend to experience later improvement plateaus compared with patients with radiculopathy-only. These findings may improve diagnosis-dependent patient education and postoperative counseling. Level of Evidence Level III.