ACDF vs. Physical Therapy for Neck and Arm Pain

Despite the fact that cervical spine conditions occur in your neck, they often have the effect of causing arm pain, numbness, or tingling—called cervical radiculopathy—that may be much worse than the neck pain.

See Could That Shoulder Pain Really Stem From the Neck?

If the pain is severe, you may face the difficult choice of whether or not to have surgery—typically an anterior cervical discectomy and fusion (ACDF) or possibly a cervical artificial disc—or to continue with nonsurgical treatments.

See Cervical Radiculopathy from a Herniated Cervical Disc

The natural course of cervical radiculopathy generally improves, although it may take a number of years. Because of this, it is hard to say which patients may benefit from surgery and which will do just as well—or maybe even better—with physical therapy instead of surgery.

See Cervical Radiculopathy from a Herniated Disc Treatment Options

Article continues below

Some factors may make ACDF more desirable

A study in Spine examined the results from a group of 60 patients, half of whom underwent an ACDF surgery followed by physiotherapy (physical therapy) and the other half had physiotherapy alone.1

See ACDF Surgery Procedure

The researchers found that certain patient factors helped predict a better outcome from ACDF surgery. The factors included:

  • Less than 12 months of arm pain and neck pain
  • Female gender
  • High levels of anxiety due to neck/arm pain
  • High level of distress before treatment

No factors were found to influence the outcome of physical therapy alone.

See Anterior Cervical Discectomy and Fusion Complications

Longer term results for surgery vs. physiotherapy may be similar

The researchers published a second study based on the same participants, which compared patient satisfaction and pain levels of the two groups over the longer term.2 They found that initially (in the one-year follow-up), the ACDF patients had significantly more satisfaction and had lower pain scores than the physiotherapy-only group.

See ACDF Surgery Postoperative Care

However, at the two-year mark for follow-up, this difference mostly disappeared—both the ACDF patients and the physiotherapy-only patients had significant reduction in neck disability, neck pain, and arm pain.

These finding suggest that, since ACDF involves a permanent decrease in range of motion, it may be worth delaying surgery to give nonsurgical treatments a chance to help.

If you are considering having an ACDF surgery for your cervical radiculopathy symptoms, talk with your surgeon about your concerns and priorities, as these will help guide your decision-making.

Learn more:

Pain Management at Home after ACDF

Physical Therapy: Passive PT (Modalities) for Back Pain


  1. Engquist M, Löfgren H, Öberg B, et al. Factors affecting the outcome of surgical versus nonsurgical treatment of cervical radiculopathy - a randomized, controlled study. Spine. 2015. Oct 15;40(20):1553-63.
  2. Engquist M, Löfgren H, Öberg B, et al. Surgery versus nonsurgical treatment of cervical radiculopathy: a prospective, randomized study comparing surgery plus physiotherapy with physiotherapy alone with a 2-year follow-up. Spine. 2013. Sep 15;38(20):1715-22.
Post written by