Comparison of anterior spinal fusion and posterior cervical foraminotomy for cervical spondylotic radiculopathy in terms of postoperative recovery of upper-limb motor deficits

Abstract

This study compared postoperative motor recovery between anterior spinal fusion (ASF) and posterior cervical foraminotomy (PCF) in patients with cervical spondylotic radiculopathy (CSR) who had motor deficits. From a database maintained by surgeons across 27 institutions, 227 patients undergoing primary ASF or PCF for CSR without myelopathy were evaluated. Among these, 106 patients with upper-limb motor deficits (manual muscle testing [MMT] grade 0–3) were observed for at least 12 months post-surgery. Data on preoperative and postoperative MMT grades were collected at 3, 6, and 12 months after surgery and at the final follow-up. The recovery of motor function was compared between the ASF and PCF groups using Kaplan–Meier curves and Cox regression analysis. While the overall excellent recovery rates (MMT grade ≥ 2) at the final follow-up were similar between the ASF and PCF group (74 % vs. 86 %, p = 0.15), the PCF group showed significantly faster motor recovery at 3, 6, and 12 months postoperatively, with recovery rates of 43 %, 63 %, and 82 %, respectively, compared to 18 %, 46 %, and 54 % in the ASF group (HR = 1.62, p = 0.031). These findings suggest that PCF may offer a quicker recovery of motor function and could be a more suitable surgical procedure than ASF for patients with CSR and motor deficits.