Should I reconsider anterior cervical discectomy and fusion (ACDF) for my 10‑month‑old cervical spondylosis with radiculopathy most severe at C5‑C6 after failed medication, physical therapy, and only six‑week relief from a second cervical epidural steroid injection?

Should You Reconsider ACDF Surgery?

Yes, you should strongly reconsider ACDF surgery now—your clinical course demonstrates failed conservative management with only temporary relief from injections, which is a clear indication for surgical intervention. 1

Why Surgery Is Now Indicated

Your situation meets all the established criteria for surgical intervention:

• Failed conservative therapy: You have completed medication, physical therapy, and two epidural injections over 10 months—well beyond the minimum 6-week trial required before surgery 1
• Temporary injection response: The 6-week relief from your second epidural injection actually confirms the correct pain generator (C5-C6) but demonstrates that non-surgical options provide only short-term benefit 1
• Persistent functional impairment: Symptoms lasting 10 months with inadequate response to comprehensive conservative care indicate you fall into the 10-25% of patients who require surgery 1

Expected Surgical Outcomes

ACDF provides 80-90% success rates for arm pain relief and 90.9% functional improvement, with rapid symptom resolution within 3-4 months 1, 2:

• Motor function recovery occurs in 92.9% of patients, with improvements maintained over 12 months 1
• Long-term durability: Neurological gains are sustained at 12-month follow-up, including improvements in strength, sensation, and pain 1
• Complication rate is approximately 5%, with good or better outcomes in 99% of patients 1

Why ACDF Is the Right Approach for C5-C6

• Direct decompression: ACDF provides direct access to your C5-C6 foraminal stenosis without crossing neural elements, addressing the exact source of nerve compression 1
• Faster relief: Surgery provides symptom resolution within 3-4 months compared to continued conservative management, which has already failed in your case 1, 3
• Single-level disease: Your severe pathology at C5-C6 is ideal for ACDF, which demonstrates excellent outcomes for single-level disease 1, 2

Surgical Technical Considerations

Anterior cervical plating (instrumentation) should be used even for your single-level fusion 1, 2:

• Reduces pseudarthrosis (non-union) risk and maintains cervical lordosis 1, 2
• Improves fusion rates and provides faster return to activities 2
• Allograft is appropriate and achieves 93.4% fusion rates at 24 months when combined with plating, eliminating donor site pain from autograft harvest 1

Critical Pitfall to Avoid

Do not continue delaying surgery based on the hope that conservative management will eventually work—you have already exhausted appropriate non-operative options 1. The natural history data shows that 75-90% of patients improve with conservative care 1, but you clearly fall into the 10-25% who require surgery. Continued delay risks:

• Prolonged disability and reduced quality of life 1
• Potential for progressive neurological deficits if motor weakness develops 1
• Unnecessary suffering when a highly effective treatment (80-90% success rate) is available 1, 2

What You Need Before Surgery

• Flexion-extension cervical X-rays to rule out segmental instability (if not already done) 2
• Confirmation that MRI findings at C5-C6 correlate with your clinical symptoms (neck/arm pain, dermatomal sensory changes, potential C6 weakness) 1
• Documentation of your conservative treatment course including specific dates, frequency, and response to therapy 1

Bottom Line

Your 10-month history of failed medication, failed physical therapy, and only 6-week relief from a second epidural injection represents a textbook indication for ACDF surgery. The temporary response to injection confirms C5-C6 as your pain generator but proves that non-surgical options cannot provide durable relief. With 80-90% success rates for arm pain relief and 90.9% functional improvement, ACDF offers you the best chance for meaningful, sustained recovery 1, 2.