Safety and efficacy of cervical foraminotomy versus anterior cervical discectomy and fusion for 1-2 level radiculopathy.

Abstract

Background: Cervical foraminotomy (CF) and anterior cervical discectomy and fusion (ACDF) are both used to treat 1-2 level cervical radiculopathy. We evaluated demographic and Patient-Reported Outcomes Measurement Information System (PROMIS) to match cohorts and compare the safety/efficacy of performing CF versus ACDF for 1-2 level unilateral radiculopathy.

Methods: This was a retrospective review of 64 patients with similar clinical and radiological data that underwent 1-2 level unilateral CF versus ACDF for cervical radiculopathy. Variables studied included operative revision rates, adverse events, surgical costs, postoperative imaging, PROMIS scores, numeric pain scores, incidence of dysphagia, frequency of vocal cord paralysis, and postoperative neurological status.

Results: We found no clinical or radiological differences between patients undergoing ACDF versus CF for unilateral 1-2 level cervical radiculopathy. Surgical differences were observed; ACDF patients demonstrated a 6.25% revision rate versus 0% for CF patients, 40% of ACDF patients reported mild dysphagia versus 0% for CF, 3% undergoing ACDF exhibited vocal cord paralysis versus 0% for CF, and ACDF incurred high implant costs (i.e., $1,836.37 and $2,773.44 for one- and two-level ACDFs) versus 0% for CF warranting no implants.

Conclusion: Patients undergoing CF versus ACDF for 1-2 level unilateral cervical radiculopathy required 3.70 fewer postoperative X-rays, 40 min less operative time, and 10.95-h shorter lengths of hospital stay (P < 0.001). Alternatively, ACDF patients had a 31.3% greater probability of achieving a minimum clinically important difference in PROMIS pain interference scores but incurred a 6.25% reoperation rate, a 40% incidence of dysphagia, and high implant costs versus 0% for CF.