Spine transforming into a blossoming tree, roots representing primary surgery and branches representing revision surgery

Neck Pain After Cervical Deformity Surgery: Understanding Recovery Kinetics

Reese Marlowe in Health & Wellness December 2025 • 5 min read.

"A new study sheds light on the recovery process following surgery for adult cervical deformity, revealing important insights for patients and surgeons."

Adult cervical deformity (ACD) can significantly diminish a person's health-related quality of life, causing pain, neurological problems, and, in extreme instances, loss of horizontal gaze. While surgery can improve pain, function, and overall quality of life, revision surgery is sometimes necessary due to the high incidence of construct failure and pseudarthrosis. Therefore, having more reliable information on recovery and long-term outcomes following revision surgery for ACD is critical.

Researchers have conducted a thorough analysis of HRQOL outcomes following primary and revision surgery for ACD. The study's primary conclusion was that, while patients undergoing revision surgery had similar HRQOL outcomes after two years compared to those undergoing primary deformity correction, their area-under-the-curve (AUC) for pain recovery was considerably smaller. The two groups had comparable complication rates. The fact that the study group was drawn from 13 spinal surgery centers across the United States makes the findings more generalizable.

This discovery is clinically significant and should influence patient counseling and expectation management. Patients considering revision surgery for ACD should be aware that they may experience more pain for a longer period during the first two years following surgery, though the long-term results should be similar to those of the original surgery. Pain is a significant issue for patients with cervical spinal disorders, and doctors have often overlooked it. According to research, alleviating neck pain is the most important factor in patient satisfaction following anterior cervical discectomy and fusion (ACDF).

Deciphering the Area-Under-the-Curve (AUC) Technique

Spine transforming into a blossoming tree, roots representing primary surgery and branches representing revision surgery

Analyzing longitudinal data with outcomes measured at multiple follow-up time points presents a challenge: determining which time point to utilize in the primary analysis. Comparing outcomes between treatment groups at a single time point (e.g., SF-36 PCS at one year) only provides a 'snapshot' of recovery at that specific moment. The AUC technique, as used by the authors, offers a potential remedy to this issue.

To begin, each patient's follow-up scores are normalized by dividing by their baseline value. These normalized follow-up scores are then plotted against time, and the AUC is calculated, yielding a single value that reflects the patient's recovery over the entire time frame. This method has the advantage of using all available data, resulting in a more accurate measure of recovery while accounting for differences in baseline scores.

Comprehensive Data Use: AUC uses all available data points, providing a holistic view of recovery.
Normalization: Adjusts for baseline score differences, ensuring fair comparisons.
Sensitive Measure: Offers a more sensitive measure of recovery than single time-point analysis.

A further step would have been to regress AUC (i.e., 'Integrated Health State') against baseline clinical, radiological, and treatment characteristics to identify independent outcome predictors, though this was not a goal. Clinical prediction models for functional outcome and complications following CSM surgery have been developed; this is an important next step in ACD research. Mixed-effects modeling with an unstructured covariance matrix and fixed effects for treatment group, time, time-by-treatment interaction, and baseline score is another option. Similar methods have been used to analyze big randomized controlled trials.

Future Research Directions

The authors have significantly contributed to the literature by publishing this work, and they should be commended. Future research should try to confirm these results in an external cohort. The retrospective nature of this study is a crucial flaw, even though the data was collected prospectively. In the age of 'big data,' and as prospective registries become increasingly prevalent, it is vital to remember that such 'retrospective analyses of prospectively collected data' are vulnerable to bias because the study hypothesis and protocol did not precede data collection.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1093/neuros/nyy448, Alternate LINK

Title: Commentary: Recovery Kinetics: Comparison Of Patients Undergoing Primary Or Revision Procedures For Adult Cervical Deformity Using A Novel Area Under The Curve Methodology

Subject: Neurology (clinical)

Journal: Neurosurgery

Publisher: Ovid Technologies (Wolters Kluwer Health)

Authors: Jetan H Badhiwala, Michael G Fehlings

Published: 2018-10-17

Everything You Need To Know

What is adult cervical deformity (ACD), and how does surgery address it?

Adult cervical deformity (ACD) is a condition that diminishes a person's health-related quality of life through pain, neurological problems, and in severe cases, loss of horizontal gaze. Surgery for ACD aims to improve pain, function, and overall quality of life. Revision surgery is sometimes needed due to issues like construct failure and pseudarthrosis. Reliable information on recovery and long-term outcomes is critical, especially following revision surgery for ACD.

How does recovery from revision surgery for adult cervical deformity (ACD) compare to primary surgery, based on recent research?

Research indicates that patients undergoing revision surgery for ACD achieve similar HRQOL outcomes after two years compared to those undergoing primary deformity correction. However, the area-under-the-curve (AUC) for pain recovery is considerably smaller in the revision surgery group, implying a longer period of pain. Complication rates are comparable between the two groups. This suggests that while long-term results are similar, patients undergoing revision surgery may experience a more extended period of pain during the initial two years post-surgery.

What is the area-under-the-curve (AUC) technique, and why is it useful for analyzing recovery after adult cervical deformity (ACD) surgery?

The area-under-the-curve (AUC) technique analyzes longitudinal data with outcomes measured at multiple follow-up time points. It normalizes each patient's follow-up scores by dividing by their baseline value, then plots these scores against time and calculates the area under the curve. This yields a single value that reflects the patient's recovery over the entire time frame. AUC utilizes all available data, adjusts for baseline score differences, and offers a more sensitive measure of recovery than analyzing outcomes at a single time point. It provides a holistic view of the recovery process.

Beyond what was covered in the study, what further analysis could be done using the area-under-the-curve (AUC) data related to adult cervical deformity (ACD) surgery?

The study could have been extended by regressing AUC (integrated health state) against baseline clinical, radiological, and treatment characteristics to identify independent outcome predictors. This would enable the creation of clinical prediction models for functional outcome and complications following ACD surgery. Additionally, mixed-effects modeling with an unstructured covariance matrix and fixed effects for treatment group, time, time-by-treatment interaction, and baseline score could offer another avenue for analysis. Such methods have been successfully used in large randomized controlled trials to gain further insights into patient outcomes.

What are the limitations of the recent research on recovery kinetics after adult cervical deformity (ACD) surgery, and what future research directions are recommended?

A primary limitation of the research is its retrospective nature, even though the data was collected prospectively. This makes the study vulnerable to bias because the study hypothesis and protocol did not precede data collection. Future research should confirm these results in an external cohort. As prospective registries become more prevalent in the age of 'big data,' it's vital to address potential biases in retrospective analyses of prospectively collected data to ensure the reliability and generalizability of the findings.