Reoperation rates after anterior cervical discectomy and fusion versus posterior cervical foraminotomy: a propensity-matched analysis

Lubelski, Daniel; Healy, Andrew T.; Silverstein, Michael P.; Abdullah, Kalil G.; Thompson, Nicolas R.; Riew, K. Daniel; Steinmetz, Michael P.; Benzel, Edward C.; Mroz, Thomas E.

doi:10.1016/j.spinee.2015.02.026

Cited by 75 publications

(60 citation statements)

References 37 publications

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Section: Introductionmentioning

confidence: 99%

“…Anterior cervical discectomy and fusion (ACDF) and posterior cervical foraminotomy (PCF) are safe and effective surgical approaches for the treatment of cervical radiculopathy. The two surgical approaches were initially reported in the 1940s and1950s and have been modified over time. Compared with PCF, ACDF has the advantages of easier and wider exposure of the intervertebral space and less patient discomfort, and has been considered the standard operation for cervical radiculopathy over the past two decades.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Anterior Cervical Discectomy and Fusion versus Posterior Cervical Foraminotomy in the Treatment of Cervical Radiculopathy: A Systematic Review

Liu

Chou

et al. 2016

Orthopaedic Surgery

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Controversy remains over whether anterior cervical discectomy and fusion (ACDF) or posterior cervical foraminotomy (PCF) is superior for the treatment of cervical radiculopathy. We therefore performed a systematic review including three prospective randomized controlled trails (RCT) and seven retrospective comparative studies (RCoS) by searching PubMed and EMBASE. These studies were assessed on risk of bias according to the Cochrane Handbook for Systematic Reviews of Interventions, and the quality of evidence and level of recommendation were evaluated according to the GRADE approach. Clinical outcomes, complications, reoperation rates, radiological parameters, and cost/cost-utility were evaluated. The mean complication rate was 7% in the ACDF group and 4% in the PCF group, and the mean reoperation rate was 4% in the ACDF group and 6% in the PCF group within 2 years of the initial surgery. There was a strong level of recommendation that no difference existed in clinical outcome, complication rate and reoperation rate between the ACDF and the PCF group. There was conflicting evidence that the ACDF group had better clinical outcomes than the PCF group (one study with weak level of recommendation). PCF could preserve the range of motion (ROM) of the operated segment but did not increase the ROM of the adjacent segment (weak level of recommendation). Meanwhile, the average cost or cost-utility of the PCF group was significantly lower than that of the ACDF group (weak level of recommendation). In conclusion, the PCF was just as safe and effective as the ACDF in the treatment of cervical radiculopathy. Meanwhile, PCF might have lower medical cost than ACDF and decrease the incidence of adjacent segment disease. Based on the available evidence, PCF appears to be another good surgical approach in the treatment of cervical radiculopathy.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of Anterior Cervical Discectomy and Fusion versus Posterior Cervical Foraminotomy in the Treatment of Cervical Radiculopathy: A Systematic Review

Liu

Chou

et al. 2016

Orthopaedic Surgery

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“…8,15 In a randomized study of 72 patients, Wirth et al 9 found similar rates of revision surgery after ACDF versus PCF, although the numbers were quite high (24% reoperation rate after ACDF vs 27% after PCF). Using a propensity-matched analysis, Lubelski et al 18 reported the reoperation rates in 188 patients who underwent ACDF versus 140 who underwent PCF. Follow-up was 2 years, and there was no statistically significant difference in revision surgery between the 2 procedures (4.8% after ACDF vs 6.4% after PCF, P = .7).…”

Section: Discussionmentioning

confidence: 99%

Risk and Cost of Reoperation After Single-Level Posterior Cervical Foraminotomy: A Large Database Study

Sayari

Tuchman

Cohen

et al. 2017

Global Spine Journal

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Study Design:Retrospective cohort study.Objective:To examine the risk of undergoing another cervical spine surgery after single-level posterior cervical foraminotomy (PCF) and analyze the costs of such reoperations.Methods:Using the PearlDiver database, we created database algorithms to identify cohorts of patients who underwent single-level PCF and also had various reoperations of interest, within 1, 2, and 4 years of follow-up. We also identified the per-patient average charge (PPAC) for each reoperation cohort.Results:In the Medicare cohort, the incidence of any reoperation was 8.3%, 9.8%, and 10.5% within 1, 2, and 4 years of follow-up, respectively. The PPAC was $8520 for the initial PCF procedure. When a second cervical surgery was performed, the PPAC was $70 349 for anterior fusion, $15 760 for posterior decompression alone, and $77 976 for posterior decompression and fusion. In the UnitedHealth cohort, the incidence of any reoperation was 13.6%, 16.7%, and 17.0% within 1, 2, and 4 years of follow-up, respectively.Conclusions:The overall incidence of another cervical spine operation was slightly higher in the Medicare population to that in previous literature, but much higher in the UnitedHealth population. The most common reoperation after PCF varied between the Medicare and UnitedHealth datasets, and costs varied widely based on the procedure performed. This study provides pertinent information that surgeons can use to discuss the risk of reoperation with their patients.

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“…Incidence of re-surgery when compared with ACDF, at the index level of surgery, was nearly same 6.4% vs 4.8% and difference was statistically insignificant. (13) Complication rates are very lowapprox. 2.2% (4) and are comparable to that of ACDF.…”

Section: Discussionmentioning

confidence: 99%

Posterior cervical discectomy: An optimally invasive approach to laterally prolapsed cervical disc

Sah¹,

Kaushik²,

Prajapati³

2016

IJN

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Aim: Posterior cervical discectomy is one of the surgical techniques for management of laterally prolapsed cervical disc causing cervical radiculopathy. This method has remained under-utilized in comparison to the classic technique of Anterior Cervical Discectomy and Fusion (ACDF). The study was conducted to evaluate it's feasibility in terms of ease, challenges and short term outcome. Material and Methods: This is a prospective study conducted over a period of 65 months. Patients visiting to neurosurgery/ orthopedics OPD's with cervical disc diseases and requiring surgery, were further evaluated on the basis of selection criteria for the feasibility of posterior cervical discectomy. Patients meeting the selection criteria were then operated upon by this approach and the outcome was evaluated. Results: Posterior cervical discectomy is essentially a disc conserving, optimally invasive microscopic technique -best suited for selected subset of patients with laterally prolapsed disc causing radiculopathy. 21 out of 23 patients appreciated the surgical benefit by as early as 48 hours of operation. There were no complications. Conclusion: Posterior cervical discectomy is an excellent direct approach to the diseased segment provided case selection criteria are properly followed.

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Reoperation rates after anterior cervical discectomy and fusion versus posterior cervical foraminotomy: a propensity-matched analysis

Cited by 75 publications

References 37 publications

Comparison of Anterior Cervical Discectomy and Fusion versus Posterior Cervical Foraminotomy in the Treatment of Cervical Radiculopathy: A Systematic Review

Comparison of Anterior Cervical Discectomy and Fusion versus Posterior Cervical Foraminotomy in the Treatment of Cervical Radiculopathy: A Systematic Review

Risk and Cost of Reoperation After Single-Level Posterior Cervical Foraminotomy: A Large Database Study

Posterior cervical discectomy: An optimally invasive approach to laterally prolapsed cervical disc

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