Anterior Cervical Diskectomy and Fusion versus Minimally Invasive Posterior Cervical Foraminotomy for the Treatment of Cervical Radiculopathy: A Meta-Analysis.

BACKGROUND

Cervical radiculopathy can be managed surgically with anterior cervical diskectomy and fusion (ACDF) or minimally invasive posterior cervical foraminotomy (MIS-PCF). ACDF is widely used and provides indirect decompression and stabilization, while MIS-PCF preserves motion, avoids fusion-related complications, and may offer advantages in perioperative recovery. The aim of this meta-analysis was to compare surgical, patient-reported, and safety outcomes of MIS-PCF versus ACDF to guide clinical decision making.

METHODS

A systematic literature search of PubMed, Scopus, Cochrane Library, and Google Scholar was conducted through October 2025 to identify comparative studies of MIS-PCF and ACDF for cervical radiculopathy. Data from 12 studies involving 3,185 patients were pooled. Outcomes included surgical time, length of stay, hospital cost, pain scores (VAS arm and neck), functional scores (NDI and EQ-5D), revision surgery rates, and complication rates.

RESULTS

MIS-PCF was associated with significantly shorter surgical time (MD = -14.72 min, P < 0.001), reduced length of stay (MD = -0.99 days, P < 0.001), and lower hospital costs (MD = -$9,131.93, P < 0.001) compared with ACDF. Arm pain outcomes showed no significant differences between groups, either immediately postoperatively (P = 0.35) or at 1 to 2 years (P = 0.71). By contrast, MIS-PCF demonstrated significantly greater neck pain reduction immediately after surgery (MD = 0.42, P < 0.001) and at 1 to 2 years (MD = -0.22, P = 0.001). Functional outcomes (NDI and EQ-5D) were comparable between techniques (P ≥ 0.89). Revision surgery and overall complication rates did not differ significantly (P = 0.39 and P = 0.51, respectively).

CONCLUSION

Both MIS-PCF and ACDF are effective surgical options for cervical radiculopathy, with comparable reported safety and functional outcomes. MIS-PCF may offer perioperative advantages and better neck pain outcomes, supporting its role as a motion-preserving and cost-efficient alternative to ACDF in appropriately selected patients.