Anterior cervical discectomy and fusion beyond radiculopathy: Improvement in vertebral artery flow and dizziness relief.

Abstract

Background: Anterior cervical discectomy and fusion (ACDF) is widely used for cervical disc disease, primarily for neural decompression. However, its potential vascular effects - particularly on vertebral artery hemodynamics and cervicogenic dizziness - remain underexplored.

Objective: The objective of this study was to evaluate whether ACDF improves vertebral artery flow and alleviates dizziness symptoms associated with impaired posterior circulation perfusion.

Methodology: A prospective case series of 40 patients with cervical radiculopathy or myelopathy underwent ACDF with polyetheretherketone (PEEK) cages. Vertebral artery peak systolic velocity (PSV) was assessed preoperatively and at 1, 3, 6, and 12 months postoperatively using duplex ultrasonography. Functional outcomes were measured with the Visual Analog Scale for neck and arm pain, the Neck Disability Index, and patient-reported dizziness. Radiographic fusion was confirmed at serial follow-up.

Results: PSV decreased significantly, indicating improved vertebral artery flow: right side from 48.85 ± 12.71 to 39.0 ± 7.45 and left side from 48.20 ± 12.02 to 41.54 ± 7.56 (both P < 0.001). Symptomatic dizziness also improved in parallel. Fusion was achieved in 92.5% by 12 months, with minor complications in 12.5%.

Conclusion: ACDF may alleviate both neural compression and extrinsic vertebral artery compromise, particularly in younger patients. Given the absence of a control group and reliance on surrogate vascular measures, these results should be considered hypothesis-generating rather than definitive.