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Objective <p>This study aims to compare the clinical outcomes of Anterior Cervical Discectomy and Fusion(ACDF)in two distinct patient populations: those with typical cervical spondylotic myelopathy (CSM), and those presenting with atypical clinical manifestations—primarily refractory low back pain accompanied by radiating lower extremity pain—who were ultimately diagnosed with Atypical Cervical Spondylotic Myelopathy (ACSM). For patients presenting with a chief complaint of low back pain accompanied by radiating pain in the lower limbs, clinicians must include high cervical cord pathologies in the differential diagnosis to avoid misdiagnosis, missed diagnosis, and unnecessary delays in treatment.</p> Background <p>ACDF is a well-established and effective surgical intervention for CSM. However, its efficacy in specific patient subgroups remains unclear and warrants further investigation—particularly in those presenting with atypical symptoms, predominantly characterized by refractory low back pain accompanied by radiating leg pain, which often mimic clinical manifestations of lumbar spine pathologies.</p> Methods <p>A total of 118 patients undergoing ACDF were enrolled and stratified into two groups according to their predominant preoperative symptoms: Group A (typical CSM) and Group B (atypical CSM). The two groups were compared regarding preoperative and postoperative outcomes, including Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), Short Form-36 Health Survey (SF-36), Oswestry Disability Index (ODI), Visual Analog Scale (VAS) scores of the back and lower limb. Surgical complications were also documented and analyzed.</p> Results <p>The two groups were comparable in terms of baseline demographics such as age, gender, BMI, duration of hospitalization, and operative time. Significant postoperative improvements were noted in JOA, NDI, and SF-36 scores for both groups (<i>P</i> &lt; 0.05).Similarly, Group B demonstrated significant postoperative improvements in the ODI score (from 55 ± 2.50 to 16 ± 1.14), back pain VAS (from 6 ± 2.3 to 2.3 ± 1.11), and lower limb pain VAS (from 5.26 ± 0.68 to 1.11 ± 0.23) (<i>P</i> &lt; 0.01). No statistically significant difference was found in the incidence of surgical complications between the two groups.</p> Conclusion <p>ACDF effectively alleviates both typical and atypical symptoms of cervical spondylotic myelopathy. This finding underscores the importance of considering cervical spine disorders in the differential diagnosis, particularly for patients presenting with unexplained low back and leg pain.</p>

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Comparative clinical outcomes of ACDF for cervical spondylotic myelopathy versus atypical cervical pathology presenting as refractory low back pain with radiating lower limb pain: a retrospective cohort study

  • 期刊论文

  • 发表日期：

    2026年2月2日

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  • Hulin Yang,
  • Xin Li,
  • Zongxian He,
  • Jie Cai,
  • Jun Wang

摘要

Objective

This study aims to compare the clinical outcomes of Anterior Cervical Discectomy and Fusion(ACDF)in two distinct patient populations: those with typical cervical spondylotic myelopathy (CSM), and those presenting with atypical clinical manifestations—primarily refractory low back pain accompanied by radiating lower extremity pain—who were ultimately diagnosed with Atypical Cervical Spondylotic Myelopathy (ACSM). For patients presenting with a chief complaint of low back pain accompanied by radiating pain in the lower limbs, clinicians must include high cervical cord pathologies in the differential diagnosis to avoid misdiagnosis, missed diagnosis, and unnecessary delays in treatment.

Background

ACDF is a well-established and effective surgical intervention for CSM. However, its efficacy in specific patient subgroups remains unclear and warrants further investigation—particularly in those presenting with atypical symptoms, predominantly characterized by refractory low back pain accompanied by radiating leg pain, which often mimic clinical manifestations of lumbar spine pathologies.

Methods

A total of 118 patients undergoing ACDF were enrolled and stratified into two groups according to their predominant preoperative symptoms: Group A (typical CSM) and Group B (atypical CSM). The two groups were compared regarding preoperative and postoperative outcomes, including Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), Short Form-36 Health Survey (SF-36), Oswestry Disability Index (ODI), Visual Analog Scale (VAS) scores of the back and lower limb. Surgical complications were also documented and analyzed.

Results

The two groups were comparable in terms of baseline demographics such as age, gender, BMI, duration of hospitalization, and operative time. Significant postoperative improvements were noted in JOA, NDI, and SF-36 scores for both groups (P < 0.05).Similarly, Group B demonstrated significant postoperative improvements in the ODI score (from 55 ± 2.50 to 16 ± 1.14), back pain VAS (from 6 ± 2.3 to 2.3 ± 1.11), and lower limb pain VAS (from 5.26 ± 0.68 to 1.11 ± 0.23) (P < 0.01). No statistically significant difference was found in the incidence of surgical complications between the two groups.

Conclusion

ACDF effectively alleviates both typical and atypical symptoms of cervical spondylotic myelopathy. This finding underscores the importance of considering cervical spine disorders in the differential diagnosis, particularly for patients presenting with unexplained low back and leg pain.