Minimally invasive posterior cervical foraminotomy with tubes to prevent undesired fusion: a long-term follow-up study

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The objective of this study was to compare anterior cervical discectomy and fusion (ACDF) and minimally invasive posterior cervical foraminotomy (MI-PCF) with tubes for the treatment of cervical radiculopathy in terms of the 1) overall revision proportion, 2) index and adjacent level revision rates, and 3) functional outcome scores.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The authors retrospectively reviewed the records of consecutive patients who had undergone ACDF or MI-PCF at a single institution between 2009 and 2014. Patients treated for cervical radiculopathy without myelopathy and with a minimum 2-year follow-up were compared according to the procedure performed for their pathology. Primary outcome measures included the overall rate of revision with fusion and overall revision proportion as well as the rate of index and adjacent level revisions per year. Secondarily, self-reported outcome measures—Neck Disability Index (NDI) and visual analog scale (VAS) for arm (VASa) and neck (VASn) pain—at the preoperative and postoperative evaluations were analyzed. Standard binomial and categorical comparative analyses were performed.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Forty-nine consecutive patients were treated with MI-PCF, and 210 consecutive patients were treated with ACDF. The mean follow-up for the MI-PCF cohort was 42.9 ± 6.6 months (mean ± SD) and for the ACDF cohort was 44.9 ± 10.3 months. There was no difference in the overall revision proportion between the two cohorts (4 [8.2%] of 49 MI-PCF vs. 12 [5.7%] of 210 ACDF, p = 0.5137). There was no difference in the revision rate per level per year (3.1 vs. 1.7, respectively, p = 0.464). Moreover, there was no difference in the revision rate per level per year at the index level (1.8 vs. 0.7, respectively, p = 0.4657) or at an adjacent level (1.3 vs. 1.1, p = 0.9056). Neither was there a difference between the cohorts as regards the change from preoperative to final postoperative functional outcome scores (NDI, VASa, VASn).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Minimally invasive PCF for the treatment of cervical radiculopathy demonstrates rates of revision at the index and adjacent levels similar to those following ACDF. In order to confirm the positive efficacy and cost analysis findings in this study, future studies need to extend the follow-up and show that the rate of revision with fusion does not increase substantially over time.</jats:p></jats:sec>

Operative treatment of cervical radiculopathy: anterior cervical decompression and fusion compared with posterior foraminotomy: study protocol for a randomized controlled trial

“…Instability issues after partial facetectomy during PF may lead problems that require fusion, in general fusion after PF have rates of up to 5%. Recent retrospective studies of minimal invasive PF with over 1000 cases shown that a good level of decompression is achieved, i.e., to same or better NDI in comparison to ACDF [22][23][24][25][26][27][28][29][30][31][32].…”

“…The preserved motion may lead to restenosis as the degeneration continues with the risk of secondary surgery on the index level [34]. PF will lead to clinical success in 64-96% with a reoperation incidence of 4-7% in retrospective cohort studies [22][23][24][25][26][27][28][29][30][31][32][35][36][37].…”

Clinical Efficacy and Safety of Surgical Treatments in Patients With Pure Cervical Radiculopathy

“…Based on a solid body of evidence, MI-PCF is a successful alternative surgery to reduce problems such as false joints, adjacent segment diseases, and anterior-related complications. MI-PCF does not necessitate the patient giving up a cervical spine motion segment, and it has a lower complication rate, a lower cost, and a faster return to movement ( 50 , 51 ). Based on the findings of this study, PCF, similar to other interventions, produced satisfactory results, with no statistical difference in postoperative success rates, post-operative complication rates, or postoperative working status, which is consistent with previous study findings ( 52 ).…”

Minimally Invasive Posterior Cervical Foraminotomy Versus Anterior Cervical Fusion and Arthroplasty: Systematic Review and Meta-Analysis

“…Overall six studies were included in quantitative synthesis including four studies that directly compare MIS-PCF to ACDF, one study that directly compares MIS-PCF to TDA, and one study that compares MIS-PCF to both ACDF and TDA. [53][54][55][56][57][58] A flow chart of study inclusion and exclusion is shown in Figure 1.…”