206. Additional surgery after anterior cervical discectomy and fusion versus posterior foraminotomy for single- or multilevel cervical radiculopathy

Abstract

BACKGROUND CONTEXT There is limited long-term comparative data for patients with cervical radiculopathy treated with either anterior cervical discectomy and fusion (ACDF) or posterior cervical foraminotomy (PCF) procedures. Therefore, the aim of the current study is to compare 5-year rates of reoperation after either ACDF or PCF for cervical radiculopathy in an older Medicare population. PURPOSE To determine the relative rates of reoperation after ACDF or PCF for cervical radiculopathy, stratified by single or multilevel disease. STUDY DESIGN/SETTING Retrospective cohort study PATIENT SAMPLE A total of 3,639 patients with single-level radiculopathy, 2,895 (80%) undergoing ACDF and 744 (20%) undergoing PCF. OUTCOME MEASURES Reoperations of the cervical spine METHODS A national sample of Medicare patients was reviewed for patients undergoing either single-level or multiple-level ACDF or PCF with a diagnosis of cervical disc herniation without myelopathy. All patients were followed for a minimum of 3 years postoperatively and rates of all additional cervical spine surgery were assessed for up to 5 years. Multivariate logistic regression was used to determine the relative odds of additional fusion surgery controlling for age, gender, and Charlson Comorbidity Index (CCI) RESULTS A total of 3,639 patients with single-level disease were identified, with 2,895 (80%) undergoing ACDF and 744 (20%) undergoing PCF. The rates of additional cervical spine surgery within 5 years were 1.7% and 1.5%, after ACDF and PCF respectively. A total of 2,986 patients had multilevel disease, with 2,785 (93%) undergoing multilevel ACDF and 201 (7%) undergoing multilevel PCF. The rates of additional cervical spine surgery within 5 years were 5.3% and 0.5%, after ACDF and PCF respectively. In multivariate analysis controlling for age, gender, and comorbidities, there was no significant difference in reoperations between ACDF and PCF in the single-level cohort. However, in the multilevel cohort, significantly more patients that underwent ACDF required additional cervical spine surgery within 5 years (odds ratio: 3.21, P = 0.048). CONCLUSIONS In the Medicare population for multilevel radiculopathy, PCF resulted in less reoperation compared with multilevel ACDF. However, no difference was seen for single level radiculopathy. Therefore, there may be some benefit in choosing PCF over ACDF in certain patients with multilevel disease. Choice of surgical technique ultimately depends on an individual patient's history, physical examination, and radiographic findings. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.