78. The impact of posterior cervical foraminotomy on neck pain: a systematic review and meta-analysis

Abstract

<h3>BACKGROUND CONTEXT</h3> Posterior cervical foraminotomy (PCF) is a safe and reasonable surgical treatment option for cervical radiculopathy. There are a plethora of studies evaluating the improvement of radiculopathy, but very few studies report on the impact of the procedure on neck pain. <h3>PURPOSE</h3> To elucidate the impact of PCF on neck pain. <h3>STUDY DESIGN/SETTING</h3> Systematic review and meta-analysis. <h3>OUTCOME MEASURES</h3> Visual analog scale (VAS) at neck and Neck Disability Index (NDI). <h3>METHODS</h3> A systematic review and meta-analysis was performed based on rules set forth by preferred reporting items for systematic reviews and meta-analysis (PRISMA). A comprehensive literature search was performed in PubMed/ MEDLINE, EMBASE and the Cochrane Library, using medical subject heading terms ("neck" and "foraminotomy") and associated text words. The search strategy was created by one author and one librarian. Two authors independently reviewed all articles and identified studies presenting clinical outcomes including VAS at neck or NDI for patients who underwent PCF for cervical radiculopathy. Exclusion criteria included patients who had surgery for myelopathy or nondegenerative cervical diseases or who underwent PCF in conjunction with laminoplasty or laminectomy with or without fusion. We also excluded studies that did not provide both pre- and postoperative outcomes, were not written in the English language, or were review articles or case reports of less than 10 patients. Meta-analysis was performed with studies that provided means with standard deviations of VAS and NDI. <h3>RESULTS</h3> The initial literature search resulted in 766 articles, of which, 30 studies were met inclusion criteria. VAS neck and NDI improved after PCF in all studies. Eleven studies (14 cohorts) with 366 patients were included in meta-analysis. The mean follow-up period was 27.1 months. Minimally invasive techniques for PCF (MI-PCF) were used in 9 articles. The mean delta improvement of VAS neck was 3.99 (95%CI 2.92-5.07, p<0.001). The mean delta improvement of VAS arm was 5.73 (95%CI 5.25-6.22, p<0.001). The mean delta improvement of NDI was 24.72 (95%CI 21.03-28.42, p<0.001). While the mean delta improvement of VAS neck in conventional PCF was 3.74 (95%CI 2.89-4.59), that in MI-PCF was 4.07 (95%CI 2.83-5.31) (p=0.66). <h3>CONCLUSIONS</h3> Contrary to popular belief, patients undergoing posterior cervical foraminotomy can expect to have improvement in their neck pain. Moreover, patients undergoing MI-PCF may experience a greater improvement in neck pain compared to open techniques. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.