Objective: Anterior cervical discectomy (ACD) has been established for 40 years. Most surgeons introduce an interbody spacer despite randomised evidence, which suggests this is unnecessary. Surgeons are concerned about the effects of discectomy on cervical spine alignment causing neck pain and accelerated degenerative changes at adjacent levels. In this study we have investigated the relationships between pre-operative disc height, post-operative radiological changes and clinical outcome following ACD.

Design: Prospective cohort study of patients undergoing ACD

Subjects: Seventy-three patients undergoing ACD for the treatment of cervical myelopathy or radiculopathy. Minimum follow up one year.

Outcome measures: SF 36, Neck Disability Index, visual analogue scores for neck and arm pain, cervical spine alignment, segmental kyphosis, and disc height.

Results: Greater pre-op disc height predicts greater post op percentage loss of disc height but does not correlate with poor outcome (p> 0.05 all measures). Post- op X-rays revealed disturbed alignment in 54% of patients. Analysis of clinical outcome showed no statistical differences in any of the clinical outcome measures between patients with and without radiological abnormalities (p> 0.05) SF 36 scores were significantly worse than population controls in patients with and without radiological abnormalities.

Conclusions: Large discs collapse more than small discs but this does not compromise outcome. Radiological changes occurred in a significant number of patients in this cohort. These abnormalities do not appear to influence clinical outcome at 12–24 months. The study continues and will report outcomes at five years.