{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:27:23Z","timestamp":1786116443371,"version":"build-2736575974"},"reference-count":34,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) can produce comparable short-term clinical outcomes, but their regional effects on cervical muscle morphology are incompletely characterized. This study compared 12-month clinical outcomes and quantitative magnetic resonance imaging (MRI) changes after single-level C6\u20137 ACDF and CDA. Methods: This retrospective longitudinal cohort included 100 age-, sex-, and body mass index-matched patients (50 ACDF and 50 CDA). Neck and arm pain were assessed on 0\u201310 scales, and the Neck Disability Index (NDI) was analyzed as a 0\u201350-point score. Regional muscle cross-sectional area (CSA) and fatty infiltration (FI) were quantified on standardized preoperative and 12-month axial T2-weighted turbo spin-echo images at C6\u20137. The primary analysis included four posterior muscles. CSA change was expressed relative to baseline, whereas FI change was expressed in percentage points. Results: Clinical outcomes were statistically indistinguishable at 12 months (neck-pain score, 0.50 vs. 0.36, p = 0.318; NDI, 2.6 vs. 2.2 points, p = 0.479; perfect-outcome rate, 68.0% in both groups). Both groups showed significant regional posterior muscle CSA reduction and FI increase; however, the magnitude was greater after ACDF than after CDA (CSA reduction, \u221215% to \u221219% vs. \u22125% to \u22129%; absolute FI increase, +5.1 to +8.2 vs. +1.1 to +2.3 percentage points; all between-group q &lt; 0.001). Surgical technique was independently associated with both MRI change metrics. Greater regional CSA reduction was modestly associated with higher concurrent 12-month neck-pain scores (\u03b2 = \u22120.26, p = 0.022). This concurrent association does not establish causation or predict outcomes beyond 12 months. Conclusions: ACDF and CDA produced equivalent measured clinical outcomes at 12 months, while CDA showed a more favorable regional posterior muscle MRI profile. Differential device-related artifact was not quantitatively assessed and cannot be completely excluded, although concordant findings across four implant-remote posterior muscles make artifact unlikely to be the sole explanation. The functional and longer-term clinical significance of this imaging difference is not established and requires prospective longitudinal study.<\/jats:p>","DOI":"10.3390\/jcm15156116","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T09:46:38Z","timestamp":1786009598000},"page":"6116","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Equivalent Clinical Outcomes but Divergent Biological Adaptation After Anterior Cervical Discectomy and Fusion Versus Cervical Disc Arthroplasty: A Longitudinal MRI Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0457-201X","authenticated-orcid":false,"given":"Evren","family":"S\u00f6nmez","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, \u0130stanbul Kanuni Sultan S\u00fcleyman Training and Research Hospital, University of Health Sciences, 34303 \u0130stanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3684-4104","authenticated-orcid":false,"given":"Lokman","family":"Ayhan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, \u0130stanbul Kanuni Sultan S\u00fcleyman Training and Research Hospital, University of Health Sciences, 34303 \u0130stanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3046-9604","authenticated-orcid":false,"given":"Said","family":"Onar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, \u0130stanbul Kanuni Sultan S\u00fcleyman Training and Research Hospital, University of Health Sciences, 34303 \u0130stanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8232-6681","authenticated-orcid":false,"given":"Ergin","family":"Anl\u0131","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, \u0130stanbul Kanuni Sultan S\u00fcleyman Training and Research Hospital, University of Health Sciences, 34303 \u0130stanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5401-1547","authenticated-orcid":false,"given":"Abdurrahim","family":"Tekin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, \u0130stanbul Kanuni Sultan S\u00fcleyman Training and Research Hospital, University of Health Sciences, 34303 \u0130stanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1343-0443","authenticated-orcid":false,"given":"Engin","family":"Can","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, \u0130stanbul Kanuni Sultan S\u00fcleyman Training and Research Hospital, University of Health Sciences, 34303 \u0130stanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7255-653X","authenticated-orcid":false,"given":"Sel\u00e7uk","family":"Yapar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, \u0130stanbul Kanuni Sultan S\u00fcleyman Training and Research Hospital, University of Health Sciences, 34303 \u0130stanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2526-3645","authenticated-orcid":false,"given":"Ak\u0131n","family":"\u00d6zt\u00fcrk","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, \u0130stanbul Kanuni Sultan S\u00fcleyman Training and Research Hospital, University of Health Sciences, 34303 \u0130stanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7219-732X","authenticated-orcid":false,"given":"Suna","family":"Dilbaz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, \u0130stanbul Kanuni Sultan S\u00fcleyman Training and Research Hospital, University of Health Sciences, 34303 \u0130stanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1625-4868","authenticated-orcid":false,"given":"Nuri Serdar","family":"Ba\u015f","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, \u0130stanbul Kanuni Sultan S\u00fcleyman Training and Research Hospital, University of Health Sciences, 34303 \u0130stanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2733-4233","authenticated-orcid":false,"given":"Serdar","family":"\u00c7evik","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, \u0130stanbul Kanuni Sultan S\u00fcleyman Training and Research Hospital, University of Health Sciences, 34303 \u0130stanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"70S","DOI":"10.1177\/2192568217701914","article-title":"A clinical practice guideline for the management of patients with degenerative cervical myelopathy: Recommendations for 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