European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026
Comparative effectiveness of posterior cervical foraminotomy versus anterior cervical discectomy with fusion for single-level cervical radiculopathy: a target trial emulation study.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Zhao Cheng, Len Weiguo, Hu Gang, Shen Yun, Lu Shengdi, Wu Meng
Аннотация
OBJECTIVE: To estimate the comparative effectiveness of posterior cervical foraminotomy (PCF) versus anterior cervical discectomy with fusion (ACDF) for single-level cervical radiculopathy in Chinese hospitals, using the target trial emulation framework guided by the FACET randomized trial protocol.
DESIGN: Target trial emulation using retrospective electronic health record data with propensity score matching and doubly robust estimation. FACET noninferiority margins served as clinical benchmarks for interpretation.
SETTING: Two Tertiary A teaching hospitals in China, January 2020 to October 2024.
PARTICIPANTS: 1876 eligible adults (890 PCF, 986 ACDF). Propensity score matching yielded 743 pairs (n = 1486).
MAIN OUTCOME MEASURES: Co-primary outcomes: Odom procedural success and visual analogue scale arm pain at 1 year.
SECONDARY OUTCOMES: neck pain, reoperation, complications, and length of stay. Approximately 43% of primary outcomes were missing; results are hypothesis-generating.
RESULTS: After matching, covariate balance was adequate (15/17 standardized mean differences < 0.10). Odom success was 82.5% for PCF versus 74.9% for ACDF (risk difference, + 7.7% points; 95% CI, 2.1 to 13.2). Mean arm pain was 23.2 versus 25.6 mm (difference, - 2.4 mm; 95% CI, - 4.8 to - 0.0), a difference well below the minimal clinically important difference and therefore not clinically meaningful. Both estimates fell within the FACET noninferiority benchmarks. Complications were lower for PCF (3.4% vs. 10.5%; P < 0.001), driven by ACDF-specific dysphagia (7.8%). Subgroup analysis showed a significant interaction by pathology type (P = 0.01); this finding is exploratory and hypothesis-generating. Results were robust across seven sensitivity analyses including doubly robust estimation and tipping-point analysis.
CONCLUSIONS: PCF and ACDF produced broadly comparable clinical outcomes at 1 year, with PCF showing fewer perioperative complications. The treatment effect varied by pathology type. Because follow-up was limited to 1 year, longer-term durability outcomes such as adjacent-segment disease, pseudarthrosis, and recurrent radiculopathy could not be assessed. These hypothesis-generating findings support further prospective investigation of PCF as a potential alternative to ACDF in selected Chinese patients.
DESIGN: Target trial emulation using retrospective electronic health record data with propensity score matching and doubly robust estimation. FACET noninferiority margins served as clinical benchmarks for interpretation.
SETTING: Two Tertiary A teaching hospitals in China, January 2020 to October 2024.
PARTICIPANTS: 1876 eligible adults (890 PCF, 986 ACDF). Propensity score matching yielded 743 pairs (n = 1486).
MAIN OUTCOME MEASURES: Co-primary outcomes: Odom procedural success and visual analogue scale arm pain at 1 year.
SECONDARY OUTCOMES: neck pain, reoperation, complications, and length of stay. Approximately 43% of primary outcomes were missing; results are hypothesis-generating.
RESULTS: After matching, covariate balance was adequate (15/17 standardized mean differences < 0.10). Odom success was 82.5% for PCF versus 74.9% for ACDF (risk difference, + 7.7% points; 95% CI, 2.1 to 13.2). Mean arm pain was 23.2 versus 25.6 mm (difference, - 2.4 mm; 95% CI, - 4.8 to - 0.0), a difference well below the minimal clinically important difference and therefore not clinically meaningful. Both estimates fell within the FACET noninferiority benchmarks. Complications were lower for PCF (3.4% vs. 10.5%; P < 0.001), driven by ACDF-specific dysphagia (7.8%). Subgroup analysis showed a significant interaction by pathology type (P = 0.01); this finding is exploratory and hypothesis-generating. Results were robust across seven sensitivity analyses including doubly robust estimation and tipping-point analysis.
CONCLUSIONS: PCF and ACDF produced broadly comparable clinical outcomes at 1 year, with PCF showing fewer perioperative complications. The treatment effect varied by pathology type. Because follow-up was limited to 1 year, longer-term durability outcomes such as adjacent-segment disease, pseudarthrosis, and recurrent radiculopathy could not be assessed. These hypothesis-generating findings support further prospective investigation of PCF as a potential alternative to ACDF in selected Chinese patients.