Comparison of Single-Level Posterior Cervical Foraminotomy to Anterior Cervical Discectomy and Fusion for Radiculopathy

Gabrielle Santangelo; Connor Wathen; Dominick Macaluso; Mert Marcel Dagli; Zarina S Ali; Neil R Malhotra; David S Casper; Michael Spadola; Yohannes Ghenbot; Khush Thakkar; Gabriella Maze; William C Welch; Ali K Ozturk

doi:10.14444/8447

Comparison of Single-Level Posterior Cervical Foraminotomy to Anterior Cervical Discectomy and Fusion for Radiculopathy

Int J Spine Surg. 2023 Jun;17(3):418-425. doi: 10.14444/8447. Epub 2023 Mar 24.

Affiliations

¹ Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA santanga@pennmedicine.upenn.edu.
² Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA.
³ Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

PMID: 36963811
PMCID: PMC10312152
DOI: 10.14444/8447

Abstract

Background: Posterior cervical foraminotomy (PCF) and anterior cervical discectomy and fusion (ACDF) are 2 commonly used surgical approaches to address cervical radiculopathy. Demonstrating superiority in clinical outcomes and durability of one of the approaches could change clinical practice on a large scale. This is the largest reported single-institutional retrospective cohort of single-level PCFs compared with single-level ACDFs for cervical radiculopathy.

Methods: Patients undergoing either ACDF or PCF between 2014 and 2021 were identified using Current Procedural Terminology codes. Medical records were reviewed for demographics, surgical characteristics, and reoperations. Statistical analysis included t tests for continuous characteristics and c2 testing for categorical characteristics.

Results: In total, 236 single-level ACDFs and 138 single-level PCFs were included. There was no significant difference in age (51.0 vs 51.3 years), body mass index (BMI; 28.6 vs 28.1), or Charlson Comorbidity Index (1.89 vs 1.68) between patients who underwent ACDF and those who underwent PCF. There was no difference in the rate of reoperation (5.1% vs 5.1%), time to reoperation (247 vs 319 days), or reoperation for recurrent symptoms (1.7% vs 2.9%) for ACDF vs PCF. Hospital length of stay (LOS) was longer for ACDF compared with PCF (1.65 vs 1.35 days, P = 0.041), and the overall readmission rate after ACDF was 20.8% vs 10.9% after PCF (P = 0.014).

Conclusions: Overall reoperation rates or reoperation for recurrent symptoms between ACDF and PCF were not significantly different, demonstrating that either procedure effectively addresses the indication for surgery. There was a significantly longer LOS after ACDF than PCF, and readmission rates at 90 days and 1 year were higher after ACDF.

Keywords: anterior cervical discectomy and fusion; posterior cervical foraminotomy; radiculopathy; readmission; reoperation.

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