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This is a retrospective long-term clinical and roentgenographic review of 50 patients who underwent anterior discectomy and fusion for painful cervical disc disease. The patients were reviewed by the senior author.To evaluate the long-term effectiveness of anterior cervical discectomy and fusion and identify clinical and roentgenographic factors that may increase the chances of recurrent problems.Many studies have demonstrated the initial effectiveness of this procedure; however, there are no previously published reports that include the results of a 21-year follow-up period.Office charts and hospital records were used to obtain information about diagnosis, surgery, and complications. On follow-up examination, all patients were interviewed and examined, and roentgenograms were obtained.Forty-eight patients had initial pain relief, and of these, 32 remained pain-free an average of 21 years after surgery. Sixteen had recurrent pain an average of 7.2 years after surgery. Eight of these required surgery for disc disease at an adjacent level. The abrupt onset of pain was the only clinical or roentgenographic factor that correlated with recurrent pain.Anterior cervical discectomy and fusion yield excellent initial results. However, patients must be cautioned that recurrent symptoms can occur, and, in a small percentage of patients, the symptoms may be severe enough to require additional surgery.