Both anterior cervical discectomy and fusion and posterior cervical foraminotomy are treatments for patients with cervical radiculopathy with similar outcomes. However, a new study seeks to determine whether their long-term reoperation rates could signify which procedure is better.
Researchers examined all patients at a facility who underwent ACDF and PCF for radiculopathy — excluding myelopathy indications — from January 2005 to December 2012 and published their findings in The Spine Journal.
Any revision occurring within two years of the initial procedure was recorded. There were 790 patients included in the study — 627 ACDF patients and 163 PCF patients. The researchers found:
1. The PCF group was significantly older and more likely male before matching. After matching, there wasn't any significant difference between the groups.
2. There was a 4.8 percent reoperation rate at the index level for the ACDF group. For the PCF group, the index level reoperation rate was 6.4 percent two years after surgery.
3. The equivalency testing, based on priori null hypothesis that clinically meaningful difference between the two groups would be 5 percent or greater, the researchers found the absolute difference was 1.6 percent, significantly less than the hypothesis.
4. Despite the belief that PCF has higher incidence of required reoperations, the researchers found reoperation rates similar with the two approaches. "The reoperation rates are statistically equivalent," concluded the study authors.
5. The study authors concluded that "spine surgeons can operate via posterior approach without putting patients at increased risk for revision surgery at the index level."