Long-term patient outcomes after posterior cervical foraminotomy: an analysis of 151 cases

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The authors conducted a study to investigate the rate and timing of reoperation due to symptom recurrence after unilateral posterior cervical foraminotomy (PCF).</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors retrospectively reviewed demographic, surgical, and clinical data from 151 patients who underwent unilateral PCF at their institution with an average follow-up of 4.15 years. The main outcome variables were reoperation rate, time to reoperation, and short- and long-term radiculopathy improvement rates. Kaplan-Meier analyses were conducted to assess risk of reoperation and recurrence of radiculopathy over time.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>After index PCF in 151 patients, the overall reoperation rate was 9.9% (15 patients). The average time until reoperation was 2.4 years, and the average last follow-up examination was 4.15 years after the first surgery. Patients who presented with preoperative neck pain in addition to radiculopathy had a higher risk for reoperation and a shorter time to reoperation. The majority of patients who underwent a reoperation had an anterior cervical discectomy and fusion (80%). A smaller number of patients had reoperation that included a repeat PCF (6.7%) or laminectomy with posterior cervical fusion (13.3%). The rate of same-level reoperation (6.6%, 10 patients) was significantly higher (p = 0.05) when compared with adjacent-segment (1.3%, 2 patients) or distant-segment (1.9%, 3 patients) reoperation. At last follow-up, the overall rate of improvement in radiculopathy was 85%, with the majority of patients (91.4%) experiencing resolution as early as 1 month after index surgery. Following the subgroup that experienced initial symptom improvement, 16.1% of these patients experienced radiculopathy recurrence an average of 7.3 years after the initial operation. While the reoperation rate for the overall cohort in this series was 9.9%, patients with follow-up periods longer than 2 years had a reoperation rate of 18.3%. Moreover, patients with more than 10 years of follow-up had a reoperation rate of 24.3%.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>PCF is a procedure performed to address nerve root compression in the cervical spine. The authors evaluated 151 patients who underwent unilateral PCF and found a reoperation rate of 9.9% at an average of 2.4 years after the initial surgery (6.6% at same level, 3.3% elsewhere). The reoperation rates reached 18.3% and 24.3% in patients with follow-up periods longer than 2 and 10 years, respectively. The authors' analysis revealed that patients with no preoperative neck pain had the lowest rates of revision surgery after PCF.</jats:p></jats:sec>

Anterior cervical discectomy and fusion versus posterior cervical foraminotomy in the treatment of brachialgia: the Leeds spinal unit experience (2008–2013)

“…However, the authors did not report the proportion of patients whose neck pain worsened or remained unchanged. Bydon et al [1] published a series of 151 patients who had PCF; 92.5 % of patients reported an improvement of neck pain. We would recommend that the traditionally held view that PCF worsens neck pain needs to re-evaluated in the light of the findings of modern retrospective studies.…”

Cervical disc replacement surgery: indications, technique, and technical pearls

“…Anterior cervical discectomy and fusion (ACDF), posterior laminoforaminotomy, laminoplasty, and laminectomy with fusion have been supported by well-designed mid-and long-term studies [1][2][3][4]. These surgical procedures provide successful means of relieving cervical radiculopathy and arresting the progression of cervical myelopathy, though each has associated complications which may lead to high rates of recurrence, adjacent segment degeneration (ASD), or need for revision surgery [2, 5-7, 8••].…”

Cervical Radiculopathy: Focused on Primary Care

“…Cervical radiculopathy is quite a common pathology in every days' consult, but its presentation is not always the commonest, which could represent a diagnostic challenge when is not suspected, which is why is so important to make a complete medical history and physical exam, and when in doubt suggest complementary studies before the disease continues to damage more the spinal nerve root and worsen the pain [21,22]. There are several different treatment options, from the less to the most invasive (not included here), but most of them lack of welldesigned studies which could support better the decision making for the physician and be more accurate when prescribing a therapy or indicating surgery.…”