Objectives: To determine the possible relation between cervical sagittal balance and neck pain in patients having anterior cervical spine (ACS) surgery. Prospective study was made to compare the clinical and radiographic results of an anterior cervical discectomy and fusion (ACDF) surgery for contiguous two-level cervical degenerative disease (CDD). The study compared clinical results as well as the cervical range of motion (ROM).

Materials and methods: After applying the inclusion criteria, 40 patients who underwent the two-level ACDF procedures were included in the study.

Clinical outcomes were assessed before and at regular intervals until one year after the procedure using the Neck Disability Index (NDI), with 15% improvement in NDI defined as a clinically significant.

The Radiological assessment was achieved by using the pre and postoperative x-rays determining the parameters for cervical sagittal balance.

Results: There was a statistically significant decrease in NDI postoperatively (p >.05). There is a statistically significant increase in the Cobb angle postoperatively (p>.05). The cervical lordosis angle significantly changed to an average of 17.72°.

Conclusions: An improvement in the cervical sagittal balance after ACS surgery is accompanied by a reduction of neck pain. Radiological parameters of cervical sagittal balance may be taken into account when planning surgery in order to maintain cervical alignment and thereby limit the occurrence of neck pain.