Does residual foraminal stenosis at levels not covered by anterior cervical discectomy and fusion aggravate postoperative outcomes in cervical radiculopathy?

Study design: Retrospective cohort study.

Purpose: To evaluate whether untreated foraminal stenosis (FS) at levels not included in anterior cervical discectomy and fusion (ACDF) impacts postoperative outcomes in patients with cervical radiculopathy and assess if residual FS increases the risk of adjacent segment disease (ASD).

Overview of literature: Level selection for ACDF for cervical radiculopathy is complex, considering variable patient anatomy and symptoms. It is unclear whether treating only potentially symptomatic levels could provide equivalent results to managing all pathologic levels.

Methods: This was a retrospective cohort study of 188 patients undergoing ACDF for degenerative cervical radiculopathy between 2014 and 2020. Patients were divided into two groups: those with all symptomatic levels decompressed (No-FS group, n=162) and those with untreated FS at levels not targeted in surgery (FS group, n=26). Postoperative outcomes, including neck pain, arm pain, and Neck Disability Index (NDI), were evaluated at 3 months and 2 years. Radiographic parameters and ASD incidence were also compared between groups.

Results: Both groups showed significant improvement in neck pain, arm pain, and NDI postoperatively, with no significant intergroup differences at 3 months and 2 years. C2-C7 lordosis and sagittal vertical axis showed similar improvement in both groups postoperatively. Rates of ASD and revision surgery did not differ significantly between No-FS and FS groups (5.6% vs. 7.7%, respectively; p=0.652). Logistic regression revealed no significant predictors of NDI improvement >50% among preoperative demographic or radiographic factors.

Conclusions: Untreated FS at levels outside the surgical target area did not adversely affect ACDF outcomes or increase ASD risk over a 2-year follow-up. These findings suggest that ACDF can be safely limited to levels directly associated with patient symptoms without compromising clinical outcomes, potentially reducing the surgical extent and associated risks.