Does the Neck Pain, Function, or Range of Motion Differ After Anterior Cervical Fusion, Cervical Disc Replacement, and Posterior Cervical Foraminotomy?

Abstract

To evaluate clinical and radiologic results as well as biomechanical changes after anterior cervical discectomy and fusion (ACDF), cervical disc replacement (CDR), and posterior cervical foraminotomy (PCF) and/or discectomy in individuals with unilateral single-level cervical radiculopathy. A total of 97 patients received surgical treatment for unilateral intolerable radiculopathy between February 2012 and August 2017. Clinical outcomes included Neck Disability Index (NDI), visual analogue scale (VAS) for neck and arm pain, and modified Odom's criteria. Range of motion (ROM) of the whole cervical (C-ROM), operated segment (S-ROM), and upper and lower adjacent segment (U-ROM and L-ROM) were measured. A total of 55 ACDFs, 21 CDRs, and 21 PCFs were performed. Clinical improvement in NDI and VAS scores were significant after surgery; however, there was no statistical significance among groups. Satisfaction rate (based on Odom's criteria) of PCF (76.2%) was inferior to that of ACDF (90.9%) and CDR (90.5%) without statistical difference. S-ROM, U-ROM, and L-ROM were slightly better in the CDR and PCF groups, without statistical significance. C-ROM significantly increased in CDR group (P= 0.04) and slightly increased in PCF group (P= 0.27). In the ACDF group, C-ROM decreased (P= 0.21) and on the contrary, the U-ROM and L-ROM increased (P > 0.05). ACDF, CDR, and PCF resulted in pain relief and improvement in neck function for patients with unilateral radiculopathy. Comparatively, ACDF provides the lowest reoperation rate. CDR is effective in ameliorating cervical ROMs. PCF has a greater probability of reoperation; however, ROM after surgery is better than with ACDF.