Surgical treatment of single level cervical radiculopathy: a comparison of anterior cervical decompression and fusion (ACDF) versus cervical disk arthroplasty (CDA) versus posterior cervical foraminotomy (PCF) Journal Article uri icon
Overview
abstract
  • STUDY DESIGN: This was a retrospective cohort study. 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.

  • Link to Article
    publication date
  • 2022
  • published in
    Research
    keywords
  • Orthopedics
  • Retrospective Studies
  • Spinal Cord
  • Surgery
  • Additional Document Info
    volume
  • 35
  • issue
  • 4