11. Foraminal decompression technique during ACDF for cervical radiculopathy that provides a better outcome: total uncinatectomy vs partial uncoforaminotomy

Abstract

BACKGROUND CONTEXT

Anterior cervical discectomy and fusion (ACDF) provides clinical improvement for cervical radiculopathy, even without direct foraminal decompression, because it stabilizes the mobile segment and provides indirect decompression. Recently, it was determined that foraminal decompression via uncinate process resection could lead to faster and greater improvement of arm pain. Total uncinatectomy (TU) and partial uncoforaminotomy (PU) are commonly used for direct foraminal decompression.

PURPOSE

However, the advantages and pitfalls of the two techniques remain unknown. We aimed to compare the clinical outcomes and complications of TU and PU to determine the most suitable technique for foraminal decompression during ACDF.

STUDY DESIGN/SETTING

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PATIENT SAMPLE

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OUTCOME MEASURES

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METHODS

Consecutive patients (n=306) who underwent single-level ACDF for degenerative cervical radiculopathy and who were followed up for >2 years were retrospectively reviewed. The patients were divided into two groups depending on the surgical technique: Group TU and Group PU. Subsidence, fusion, operative time, estimated blood loss (EBL), complications, and patient-reported outcome measures including arm pain visual analogue scale (VAS) score, neck pain VAS score, and neck disability index (NDI) were assessed and compared between the two groups.

RESULTS

Groups TU and PU included 152 (49.7%) and 154 (50.3%) patients, respectively. Group TU had a significantly higher degree of subsidence than Group PU. The 1-year (16 [10.5%] vs 6 [3.9%], p=0.025) and 2-year (11 [7.2%] vs 3 [1.9%], p=0.025) postoperative fusion rates were higher in Group PU than those in Group TU (16 [10.5%] vs 6 [3.9%], p=0.027). Postoperative arm pain VAS score, neck pain VAS score, and NDI scores did not demonstrate significant intergroup differences at all time points. Group TU had a significantly longer operative time (94.21±15.74 vs 81.04±16.92, p < .001), greater EBL (121.34±109.9 vs 71.83±85.71, p<.001), higher dysphasia rate (94 (61.8%) vs 75 (48.7%), p=0.021), and more severe retropharyngeal soft tissue swelling (18.20±5.02 vs 15.98±3.73, p=0.016) than Group PU did. There was one case (0.7%) of cerebral infarction due to vertebral artery injury in Group TU.

CONCLUSIONS

PU resulted in lesser complications, shorter operative time, and lesser intraoperative bleeding than did TU. While TU guarantees complete foraminal decompression during ACDF, it requires a longer time. Furthermore, excessive lateral exposure and retraction is needed to palpate the lateral margin of the uncinate for TU. This might cause greater postoperative neck swelling and dysphagia. Moreover, the uncinate process was partially preserved in PU as a potential stabilizer, causing lesser subsidence and higher fusion rates. However, the clinical efficacy of PU was comparable to that of TU. Thus, resection of only the posterior part of the uncinate process provides sufficient direct foraminal decompression. Therefore, PU could be an effective and safer alternative to TU for foraminal decompression during ACDF.

FDA Device/Drug Status

This abstract does not discuss or include any applicable devices or drugs.