Medium Term Outcomes of Single-Level Posterior Cervical Foraminotomy versus Single-Level Anterior Cervical Decompression and Fusion versus Single-Level Cervical Disc Replacement for Cervical Radiculopathy.

STUDY

DESIGN

Retrospective cohort study.

OBJECTIVE

To compare rates of revision fusion after posterior cervical foraminotomy, anterior cervical decompression and fusion, and total disc replacement for radiculopathy.

SUMMARY OF BACKGROUND DATA: Cervical radiculopathy is one of the most common conditions in the US. Surgical treatment typically involves a single-level anterior cervical decompression and fusion (ACDF). However, the posterior cervical foraminotomy (PCF) and the total disc replacement (TDR) have become popular options. Few studies have reviewed how rates of subsequent revision surgery differ between the three procedures.

METHODS

The TriNetX Global Collaborative Network database was queried using ICD-10 and CPT codes to identify adult patients (≥ 18 years old) diagnosed with cervical radiculopathy who underwent single-level ACDF, TDR, or PCF within the past 20 years. Propensity score matching (1:1) was performed and rates of revision ACDF were evaluated at 1-year and 3-year post-operatively.

RESULTS

At 1-year post-operatively, ACDF (RR 0.63, P = 0.017) had lower risk for subsequent ACDF versus PCF. Foraminotomy had a higher risk for subsequent ACDF compared with index TDR (RR 2.56, P < 0.001). Similar outcomes were seen at 3-years post-operatively. Patients with an index ACDF had a significantly higher risk at 3-year versus TDR (RR = 1.68, P = 0.027), and a non-significant elevated risk of implant-related complication at both 1-year (RR = 1.3, P = 0.45), and 3-year (RR = 1.39, P = 0.28) versus TDR.

CONCLUSION

TDR tended to have the lowest risk of subsequent ACDF and implant failure at both 1-year and 3-year, while PCF had the highest risk of subsequent ACDF compared with both the index ACDF and index TDR group.

LEVEL OF EVIDENCE: IV.