Comparing Mid-Term Outcomes Between ACDF and Minimally Invasive Posterior Cervical Foraminotomy in the Treatment of Cervical Radiculopathy

Abstract

Study Design. Retrospective cohort study. Objective. To compare minimally invasive posterior cervical foraminotomy (MI-PCF) and anterior cervical discectomy and fusion (ACDF) in the treatment of unilateral cervical radiculopathy. Summary of Background Data. MI-PCF has been shown to be equally effective as ACDF in treating cervical radiculopathy due to foraminal stenosis and similar pathologies. Additionally, it has been hypothesized that preserving motion and avoiding fusion reduces risk for adjacent segment disease, but potentially increases risk for subsequent revision to an ACDF. With similar short-term outcomes and substantial advantages, MI-PCF may be an effective alternative to ACDF for addressing appropriate cervical pathology. Methods. A retrospective review was performed to identify patients between 2009 and 2013 who underwent ACDF or MI-PCF with a minimum follow-up of 7 years. Demographic data was recorded. Revision rates and average time to revision between cohorts were compared. Clinical outcomes were assessed at each follow-up visit with Neck Disability Index and Visual Analog Scale for neck and Visual Analog Scale for arm pain scores. All complications were reviewed. Standard binomial and categorical comparative analysis were performed. Results. A total of 251 consecutive patients were included (205 ACDF, 46 MI-PCF). Mean follow-ups for the ACDF and MI-PCF groups were 98.3 and 95.9 months, respectively. Complication rates were 2.9% and 2.2% for the ACDF and MI-PCF cohorts, respectively (P ¼ 0.779). Revision rates were 7.8% for the ACDF cohort and 8.7% for the MI-PCF cohort (P ¼ 0.840). Both cohorts experienced significant improvements in their clinical scores compared with their preoperative values. Final Visual Analog Scale for neck pain (ACDF: 2.6; MI-PCF: 1.6) and Visual Analog Scale for arm pain (ACDF: 1.1; MI-PCF: 0.4) scores differed significantly at final follow-up (P ¼ < 0.001; P ¼ < 0.001). Conclusion. MI-PCF is a safe and effective alternative to ACDF in the treatment of cervical radiculopathy, demonstrating substantial benefit. After final follow-up, MI-PCF demonstrated superior improvements in Visual Analog Scale scores, without increased complication or revision rates.

Single-level Anterior Cervical discEctomy and Fusion has Lower Five-year Revisions than Posterior Cervical Foraminotomy in a Large National Cohort

“…Building on prior retrospective cohort studies, 8,9 Ruetten et al performed a prospective, randomized controlled study comparing 100 ACDF to 100 PCF patients with lateral cervical disk herniation and found no significant differences between cohorts in perioperative complications or two-year revision rates 10 . Another randomized control trial by Wirth et al found no significant difference in combined scores of pain improvement, resolution of neurological defects, return to work at two-month follow-up, or rates of reoperation 11 …”

“…The literature comparing outcomes for single-level ACDF versus PCF is mixed. In terms of retrospective cohort studies, Lin et al showed PCF is associated with higher rates of reoperation compared with ACDF, 8 while Emami et al found no difference in reoperation rates 9 . Building on these, randomized control studies by Ruetten et al 10 and Wirth et al 11 found no significant differences in postoperative complication or reoperation rates.…”

Long-Term Clinical Results of Percutaneous Cervical Nucleoplasty for Cervical Radicular Pain: A Retrospective Cohort Study

“…This reoperation rate is comparable with the reoperation rates of ACDF, ie 7.8% to 15%. 29 , 30 Kessinger studied the rate of reoperation after PCN and identified a reoperation rate of 19.5% in his study population of 133 patients. 31 This rate appears to be somewhat higher than the rate we found in our study.…”

Bone Wax Occlusion: A Simple Method for managing Cerebrospinal Fluid Leakage during Anterior Cervical Discectomy and Fusion Surgery

“…With the advancement of technology in recent years, for some cervical spondylotic radiculopathy, the posterior endoscopic cervical foraminoplasty can also alleviate pain very well without increasing the repair rate and complications [20]. Cervical disc replacement can preserve the motor function of surgical segments and theoretically reduce the probability of degeneration of adjacent segments.…”