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Objective: The objective of this study is to retrospectively compare the clinical outcomes, complication rates, and reoperation rates among the 4 treatments in patients with cervical radiculopathy.Summary of Background Data: Surgical options for cervical radiculopathy include anterior cervical discectomy and fusion (ACDF), open posterior cervical foraminotomy (O-PCF), minimally invasive posterior cervical foraminotomy (MI-PCF), and cervical disk arthroplasty (CDA).Materials and Methods: Retrospective chart review after Review Board approval. Of the 384 patients in the study-257 ACDF, 18 O-PCF, 52 MI-PCF, and 56 CDA. Information was obtained from the charts and compared between the groups.Patient Sample: Patients above 18 years of age with single-level, unilateral cervical radiculopathy correlating with magnetic resonance imaging, failure of nonoperative management, and 1-level ACDF, O-PCF, MI-PCF, or CDA with > 24 months of follow-up.Outcome Measures: Neck Disability Index (NDI), Visual Analog Score neck and arm pain, minimum clinically significant difference (MCID), complication rates, and reoperation rates.Results: Operative time was significantly shorter for MI-PCF. Median estimated blood loss was small, but greater with O-PCF compared with other interventions. The length of hospital stay was longest for the ACDF group. At 2 years' follow-up, 36 subjects (9%) had subsequent neck surgery. The most common indication for additional surgery was recurrent symptoms (3.4%) followed by adjacent segment disease (2.6%), pseudoarthrosis (2.1%), adjacent segment disease + pseudoarthrosis (0.5%), and implant-related complications (0.3%). There was no statistically significant difference in complication rates between groups. MCID in NDI was achieved in 40% of MI-PCF subjects, 42% of O-PCF subjects, 66% of CDA subjects and 46% of ACDF subjects.Conclusions: All 4 treatment options confer good clinical results on patients for cervical radiculopathy. Intraoperative and postoperative complications were low and comparable in all 4 groups. MI-PCF had the shortest surgical time and length of hospital stay. More CDA patients achieved MCID in NDI compared with the others, and the rate for additional surgery at 2 years was lowest in the CDA group.

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Background: Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are attractive targets for transition to the outpatient setting. We assessed the prevalence of rapid responses and major complications in the inpatient setting following 1 or 2-level ACDFs and CDAs. We evaluated factors that may place patients at greater risk for a rapid response or a postoperative complication.Methods: This was an institutional review board-approved, retrospective cohort study of adults undergoing 1 or 2-level ACDF or CDA at 1 hospital over a 2-year period (2018 and 2019). Data on patient demographic characteristics, surgical procedures, and comorbidities were collected. Rapid response events were identified by hospital floor staff and involved acute changes in a patient's clinical condition. Complications were events that were life-threatening, required an intervention, or led to delayed hospital discharge.Results: In this study, 1,040 patients were included: 888 underwent ACDF and 152 underwent CDA. Thirty-six patients (3.5%) experienced a rapid response event; 22% occurred >24 hours after extubation. Patients having a rapid response event had a significantly higher risk of developing a complication (risk ratio, 10; p < 0.01) and had a significantly longer hospital stay. Twenty-four patients (2.3%) experienced acute complications; 71% occurred >6 hours after extubation. Patients with a complication were older and more likely to be current or former smokers, have chronic obstructive pulmonary disease, have asthma, and have an American Society of Anesthesiologists (ASA) score of >2. The length of the surgical procedure was significantly longer in patients who developed a complication. All patients who developed dysphagia had a surgical procedure involving C4-C5 or more cephalad. Patients with a rapid response event or complication were more commonly undergoing revision surgical procedures.Conclusions: Rapid response and complications are uncommon following 1 or 2-level ACDFs or CDAs but portend a longer hospital stay and increased morbidity. Revision surgical procedures place patients at higher risk for rapid responses and complications. Additionally, older patients, patients with chronic obstructive pulmonary disease or asthma, patients who are current or former smokers, and patients who have an ASA score of ‡3 are at increased risk for postoperative complications.

Study Design: Retrospective matched cohort study. Summary of Background Data: With a growing interest in minimally invasive spine surgery (MIS), the question of which technique is the most advantageous for patients with low-grade degenerative lumbar spondylolisthesis (DLS) still remains unclear. Objective: To compare patient-reported outcomes, perioperative morbidity, and rates of reoperation between MIS decompression with either unilateral noninstrumented facet fusion (MIS-F) or with transforaminal interbody fusion (MIS-T) for grade 1 DLS. Methods: Twenty patients who underwent MIS-T and 20 patients with MIS-F were matched based on age, sex, and preoperative ODI, VAS back, and VAS leg. All patients had DLS with at least 4 millimeters of translation on standing radiographs. Exclusion criteria included prior level surgery, multilevel instability, disk impinging on the exiting nerve root, spondylolisthesis from significant facet arthropathy, or foraminal compromise from disk collapse. ODI, VAS back, VAS leg, and patient satisfaction measured by the North American Spine Society questionnaire were tracked at 3, 6, 12, and 24 months postoperatively. Minimum clinically important differences and substantial clinical benefits were calculated. Results: MIS-F and MIS-T resulted in decreased ODI at 3, 6, and 12 months following the index procedure. Sixty percent of MIS-F and 83% of MIS-T patients reached minimum clinically important difference at 1 year postoperatively; however, using the threshold of 30% ODI reduction from baseline, 67% of MIS-F and 83% MIS-T (P = 0.25) achieved this goal. Forty-three percent of MIS-F and 59% of MIS-T patients met substantial clinical benefits. Satisfaction at 1 year, measured by a score of 1 or 2 on the North American Spine Society questionnaire, was 64% for MIS-F and 83% for MIS-T. Conclusions: MIS-F and MIS-T are effective treatment options for spinal stenosis associated with low-grade DLS. Both techniques result in comparable patient-reported outcomes and satisfaction up to 2 years and have similar long-term reoperation rates. More evidence is required to delineate optimal selection characteristics for MIS-F versus MIS-T.