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. 2023 Jun;17(3):418-425.
doi: 10.14444/8447. Epub 2023 Mar 24.

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

Gabrielle Santangelo  1   2 , Connor Wathen  3 , Dominick Macaluso  3 , Mert Marcel Dagli  3 , Zarina S Ali  3 , Neil R Malhotra  3 , David S Casper  3 , Michael Spadola  3 , Yohannes Ghenbot  3 , Khush Thakkar  3 , Gabriella Maze  3 , William C Welch  3 , Ali K Ozturk  3
Affiliations

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

Gabrielle Santangelo et al. Int J Spine Surg. 2023 Jun.

Abstract

Background: Posterior cervical foraminotomy (PCF) and anterior cervical discectomy and fusion (ACDF) are 2 commonly used surgical approaches to address cervical radiculopathy. Demonstrating superiority in clinical outcomes and durability of one of the approaches could change clinical practice on a large scale. This is the largest reported single-institutional retrospective cohort of single-level PCFs compared with single-level ACDFs for cervical radiculopathy.

Methods: Patients undergoing either ACDF or PCF between 2014 and 2021 were identified using Current Procedural Terminology codes. Medical records were reviewed for demographics, surgical characteristics, and reoperations. Statistical analysis included t tests for continuous characteristics and c2 testing for categorical characteristics.

Results: In total, 236 single-level ACDFs and 138 single-level PCFs were included. There was no significant difference in age (51.0 vs 51.3 years), body mass index (BMI; 28.6 vs 28.1), or Charlson Comorbidity Index (1.89 vs 1.68) between patients who underwent ACDF and those who underwent PCF. There was no difference in the rate of reoperation (5.1% vs 5.1%), time to reoperation (247 vs 319 days), or reoperation for recurrent symptoms (1.7% vs 2.9%) for ACDF vs PCF. Hospital length of stay (LOS) was longer for ACDF compared with PCF (1.65 vs 1.35 days, P = 0.041), and the overall readmission rate after ACDF was 20.8% vs 10.9% after PCF (P = 0.014).

Conclusions: Overall reoperation rates or reoperation for recurrent symptoms between ACDF and PCF were not significantly different, demonstrating that either procedure effectively addresses the indication for surgery. There was a significantly longer LOS after ACDF than PCF, and readmission rates at 90 days and 1 year were higher after ACDF.

Keywords: anterior cervical discectomy and fusion; posterior cervical foraminotomy; radiculopathy; readmission; reoperation.

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Conflict of interest statement

Declaration of Conflicting Interests : The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Comorbidities by surgery type. There was no significant difference between groups in preoperative comorbidities. The most commonly observed comorbidities were chronic obstructive pulmonary disease and diabetes mellitus in both groups. ACDF, anterior cervical discectomy and fusion.
Figure 2
Figure 2
Cervical levels treated by surgery type. There was a significant difference between groups in the levels most commonly treated. Within the anterior cervical discectomy and fusion (ACDF) group, patients most often underwent surgery at the C5-C6 level followed by C6-C7 vs the posterior cervical foraminotomy group that more frequently underwent decompression at C6-C7 followed by C5-C6.
Figure 3
Figure 3
Reasons for reoperation of total cohort. Reoperation was most commonly performed for recurrent symptoms in both groups followed by instrumentation-related complications such as pseudarthrosis and adjacent segment disease.
Figure 4
Figure 4
Reasons for reoperation by surgery type. Reoperation for recurrent symptoms was not statistically different between groups. There was significantly more reoperation for adjacent segment disease in the anterior cervical discectomy and fusion (ACDF) group. There were more reoperations for wound infections in the posterior cervical foraminotomy group.
See this image and copyright information in PMC

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