Clinical and radiological outcomes of anterior cervical foraminotomy: Insights from a pioneering Australian case series and systematic review.

BACKGROUND

Anterior cervical foraminotomy (ACF) is a motion-preserving technique that directly addresses anterior and lateral pathologies without requiring fusion. Despite its theoretical advantages, there are few reported series in the literature and its long-term impact of spinal alignment and degeneration remains unexplored. This is the first Australian case series reporting our experience with ACF.

METHODS

We retrospectively reviewed 49 patients (79 levels) who underwent ACF. Clinical outcomes were measured using validated scoring systems. Radiological measurements were made from pre- and postoperative radiographs to look for signs of degeneration at the operated/adjacent levels and change to overall alignment. A comprehensive systematic review was performed to assess the clinical, radiological, and complication outcomes of ACF.

RESULTS

46 patients with 73 operated levels (21 single-level) were included. Average follow-up was 28.3 months. Significant clinical and functional improvements were observed in all patients (VAS neck: 7.29 vs. 1.4, VAS arm: 8.15 vs. 1.15, NDI: 27.55 vs. 3.26, P < 0.05). 4 out of 73 levels (5.5 %) required revision fusion surgery with symptom recurrence. There was no significant difference in focal and segmental angles or overall alignment. Range of motion was preserved. A small but statistically significant reduction in disc height was observed at the operated level (4.68 vs 4.21) and the level above (5.69 vs. 5.47) but not the level below.

CONCLUSION

ACF is a safe and effective motion-preserving technique for cervical radiculopathy, with durable symptom relief and minimal radiological changes that are unlikely to carry clinically significant implications. This study represents the first documented Australian experience with ACF and a systematic review of the literature, with analysis of clinical and radiological outcomes.