Surgical Treatment of Single Level Cervical Radiculopathy

Abstract

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.

Short-Term Neck Pain After Posterior Foraminotomy Compared with Anterior Discectomy with Fusion for Cervical Foraminal Radiculopathy

“…Moreover, despite the majority of patients having reached or exceeded the predefined MCID threshold for improvement in VAS neck pain at postoperative week 6 (0.58 percentage points in the posterior surgery group and 0.60 percentage points in the anterior surgery group), one might argue that relatively large proportions of patients did not reach this level or exceeded it. One retrospective study showed even lower rates of achieving the same MCID value after a 2-year follow-up (50% in the posterior surgery group and 51% in the anterior surgery group), although it did not report measures of uncertainty 23 . Among 3 studies analyzing MCID achievement after anterior surgery, of which 2 studies used a combined VAS for arm and neck pain, marked variation was demonstrated in MCID achievement rates ranging from 46% to 88% [24][25][26] .…”

Comparison of Single-Level Posterior Cervical Foraminotomy to Anterior Cervical Discectomy and Fusion for Radiculopathy

“…Prior studies have shown a longer LOS for single-level ACDFs vs PCF for radiculopathy, with PCFs most often discharging to home on the day of surgery, though a small randomized controlled trial (RCT) did not show any difference. 7,11,12 Readmission after ACDF has been shown to cost approximately $6727 per patient admission. 13 Though ACDFs have a lower 30-day readmission rate when compared with International of Spine Surgery, Vol.…”

“…13,16 Reoperation rates in previous studies have ranged from 4% to 28% after ACDF and from 5% to 27% after PCF. 5,[10][11][12][16][17][18][19] Lubelski et al recently published the first propensity-matched retrospective analysis comparing 188 ACDFs with 140 PCFs at a single center with 2-year follow-up and found that the same-level reoperation rate was not significantly different, 4.8% compared with 6.4%, respectively. Unsurprisingly, reoperation rates for ASD are more common after fusion procedures as are reoperations for pseudarthrosis after PCFs.…”

“…ASD and pseudarthrosis after ACDF have been cited at a rate of 3% and 3.1%. 11,20 Wound infections have been cited to be the most common complication after PCF, ranging from 1% to 4.5%. 5,11,[21][22][23] Risk factors for reoperation in this population are younger age, male patients, preoperative diabetes, and lower BMI, which were not demonstrated using linear regression in our cohort.…”

“…11,20 Wound infections have been cited to be the most common complication after PCF, ranging from 1% to 4.5%. 5,11,[21][22][23] Risk factors for reoperation in this population are younger age, male patients, preoperative diabetes, and lower BMI, which were not demonstrated using linear regression in our cohort. 16,24,25 The subsequent surgical approach for recurrent symptoms has been shown to favor ACDF, regardless of the approach of the index surgery.…”