17. Comparison of clinical results between minimally invasive cervical foraminotomy and anterior cervical decompression and fusion for cervical radiculopathy

BACKGROUND CONTEXT

As a surgical procedure for cervical radiculopathy, anterior cervical decompression and fusion (ACDF) or posterior foraminotomy is generally performed. Recently, the efficacy of minimally invasive cervical posterior foraminotomy has been reported. However, few studies have compared the postoperative clinical outcomes of minimally invasive cervical foraminotomy with those of ACDF. Nor have complications from their surgical procedure been compared.

PURPOSE

The purpose of this study was to clarify the efficacy of cervical microendoscopic foraminotomy (CMEF) compared with ACDF for the treatment of cervical disorders with radiculopathy.

STUDY DESIGN/SETTING

This study design is a retrospective subgroup analysis of a prospectively collected cohort analysis.

PATIENT SAMPLE

Consecutive patients with cervical radiculopathy who required surgical treatment were enrolled. The patients were diagnosed with cervical radiculopathy due to disc herniation or degenerative spondylosis on imaging including MRI and CT scan. Surgical treatment was selected when conservative treatment for more than 3 months was not effective. All enrolled patients (n = 79) underwent CMEF or ACDF.

OUTCOME MEASURES

All patients were reviewed postoperatively for greater than 1 year. The preoperative and 1-year follow-up evaluations included neurological assessment. The primary outcome measure was the numeric rating scale (NRS) for neck and arm pain with a minimal clinically important difference defined as >15%. Secondary outcomes were assessed with additional patient reported outcomes measures (PROMs).

METHODS

Nominal variables were compared using the Chi-squared test, or Fisher's exact test if the sample was ≤10. The Mann – Whitney test was used to compare medians of ordinal variables and the independent-samples t-test was used to compare the means of continuous variables. The complication rate was analyzed using a matched-pairs t-test. To evaluate changes in the NRS score following each surgery a repeated-measures analysis of variance was used. A p-value ≤0.05 was defined, a-priori, as statistically significant.

RESULTS

CMEF was performed in 55 patients and 24 patients underwent ACDF. The mean preoperative NRS for neck and arm pain was respectively 5.6 and 6.0 points in the CMEF group and 5.2 and 5.6 points in the ACDF group (p>0.05). In both groups, their NRS improved significantly 1 year after surgery (p<0.05), and there were no significant differences between the groups (p>0.05). The VAS of surgical satisfaction was 82 mm in the CMEF group and 83 mm in the ACDF group (p>0.05). There was no significant difference between the groups in SF-36. As for perioperative complications, in the CMEF group, 3 patients had temporary muscle weakness over MMT1 grade, and 2 patients had temporary progressive numbness. In the ACDF group, 1 patient had a temporary dysphagia.

CONCLUSIONS

Patients with cervical disorders with radiculopathy were clinically improved in both groups, at 1-year follow-up, which were comparable. However, the transient neurological deterioration had clinically important differences in each group. CMEF had some complications related to nerve root, and ACDF had dysphagia.

FDA Device/Drug Status

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