17. Seven-year outcomes of ACDF vs minimally invasive posterior cervical foraminotomy in the treatment of cervical radiculopathy

Abstract

<h3>BACKGROUND CONTEXT</h3> Minimally invasive posterior cervical foraminotomy (MI-PCF) is a motion sparing technique that has been shown in several studies to be similarly effective as ACDF in treating cervical radiculopathy due to foraminal stenosis and other related degenerative pathologies. MI-PCF also has several advantages over ACDF as it is associated with fewer hardware complications, shortened hospital stay, reduced blood loss and cost. It has been hypothesized that preserving motion may reduce the risk of the development of adjacent segment disease (ASD) in MI-PCF vs ACDF. Recent studies have shown a similar revision rate between MI-PCF and ACDF at 2-year follow-up; however, long-term follow-up data comparing MI-PCF vs ACDF are scarce. <h3>PURPOSE</h3> The purpose of this study is to compare outcomes of MI-PCF and ACDF in the treatment of unilateral cervical radiculopathy over long-term (>7 years) follow-up. <h3>STUDY DESIGN/SETTING</h3> Retrospective comparative study. <h3>PATIENT SAMPLE</h3> A total of 177 consecutive patients at a single institution who underwent ACDF or MI-PCF between 2009-2013 with a minimum follow-up of 7 years. <h3>OUTCOME MEASURES</h3> (1) Patient demographics; (2) complication rate; (3) revision rate; (4) patient-reported outcome scores Neck Disability Index (NDI), Visual Analog Score for neck (VAS-n) and arm (VAS-a). <h3>METHODS</h3> A retrospective review was performed to identify all patients between 2009-2013 who underwent either ACDF or MI-PCF with a minimum follow-up of 7 years. Demographic data were recorded and compared between both cohorts. Revision rates and complication rates between ACDF and MI-PCF were also compared. Patient-reported outcome scores were assessed with NDI, VAS-n, and VAS-a measurements at follow-up visits. Standard binomial and categorical comparative analysis were performed. <h3>RESULTS</h3> A total of 177 consecutive patients were included–143 in the ACDF cohort and 34 in the MI-PCF cohort. There were 60 males and 83 females in the ACDF cohort compared to 29 males and 9 females in the MI-PCF cohort, a statistically significant difference (p <0.001). Mean follow-up of the ACDF and MI-PCF cohorts were 96.8 and 94.5 months, respectively. Complication rates were 4.9% and 2.9% for the ACDF and MI-PCF cohorts, respectively (p =1.0). The overall revision rates were 9.1% for the ACDF cohort and 11.8% for the MI-PCF cohort (p=0.745). All MI-PCF patients were revised to a fusion. Both cohorts experienced significant improvements in their functional outcome scores compared to their preoperative values; however, the magnitude of improvement was not statistically significant between the ACDF and MI-PCF cohorts. <h3>CONCLUSIONS</h3> MI-PCF is a safe and effective alternative to ACDF in the treatment of unilateral cervical radiculopathy without myelopathy, demonstrating benefit at a minimum of 7-year follow up. MI-PCF demonstrated similar improvements in functional outcome scores, without increased complication or revision rates. Further studies should consist of cost analysis to evaluate how utilizing MI-PCF would impact overall health care spending. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.