Disc degeneration is a natural part of growing older. Up to 60% of asymptomatic people have MRI findings that are positive. As a result, MRI only provides morphological information and may not be able to determine the clinical significance of the findings.

Many authors believe that patients who suffer from cervical radiculopathy as a result of degenerative disease and have multilevel pathology on imaging studies still have moderate surgical outcomes. This occurs due to a misdiagnosis or the need to perform surgery on multiple levels despite a single painful lesion.

Although the complication rate for 1- and 2-level ACDF is so low that it is considered one of the safest procedures in spine surgery. There is concern that increasing levels of fusion will lead to more complications, such as a higher incidence of persistent axial neck pain, dysphagia, and vertebral artery injury, as well as more postoperative pain and higher narcotic dosages.

Inclusion Criteria:

• all patients presented with unilateral brachialgia due to multilevel cervical disc disease

Exclusion Criteria:

• multilevel cervical disc disease who had bilateral brachialgia,
• myelopathy, double crush syndrome,
• ossified posterior longitudinal ligament (OPLL),
• combined anterior and posterior pathology requiring posterior decompression