Unilateral Cervical Radiculopathy Research Articles

Simultaneous versus consecutive administration of cervical traction and neural mobilization in patients with cervical radiculopathy: A randomized controlled trial

Background & Objective: Cervical traction and neural mobilization are frequently utilized in the management of cervical radiculopathy. However, there is a paucity of literature concerning the best order of application of these techniques. The aim of this study was to compare the effects of simultaneous and consecutive administration of cervical traction and neural mobilization on pain and function in cervical radiculopathy. Methods: Thirty patients were randomly assigned to two equal groups: consecutive (CON) and simultaneous (SIM) cervical traction and neural mobilization in this single-blind randomized controlled trial. The inclusion criteria comprised age 20-60 years, unilateral cervical radiculopathy ≥ 6 months, and positive upper limb neural tension tests of radial, median or ulnar nerve, and positive Spurling test. Outcome measurement tools were numeric pain rating scale, cervical goniometry, neck disability index, and short-form health survey. Data was analyzed with SPSS 23. Results: Significant improvement was evident in all parameters in CON after 1-week rehabilitation (P≤0.001 for seven of the ten variables). Similarly, all parameters showed significant improvement in SIM (P≤0.001 for all variables except mental component score of SF-12 with P<0.05). After rehabilitation, SIM was significantly better with respect to pain (P<0.05), flexion-extension mobility (P<0.001), and quality of life (P<0.01). No differences were found in other variables. Conclusion: Simultaneous use of cervical traction and neural mobilization resulted in significantly better outcomes with regards to pain, flexion-extension mobility, and quality of life. The two groups performed similarly on other outcome measures.

Inter-rater and intra-rater reliability of manual assessment of respiratory motion in patients with unilateral cervical radiculopathy: A cross-sectional study

BackgroundAltered breathing pattern is a consequence of dysfunctional breathing. The respiratory pattern might be impaired in patients with cervical radiculopathy due to the involvement of common nerve roots with the phrenic nerve (C3– C5). ObjectiveThe aim of this study was to investigate the inter-rater and intra-rater reliability of a technique for evaluating the breathing pattern known as manual assessment of respiratory motion (MARM) in patients with unilateral cervical radiculopathy. DesignCross-sectional study. SettingRehabilitation Sciences Research Center ParticipantsTwenty-five patients with unilateral cervical radiculopathy aged 30–55 years participated in this study. MethodsTwo experienced physical therapists investigated the respiratory pattern of the patients during normal and deep breathing using MARM, separately. Assessments were repeated again a week apart by each examiner. The inter- and intra-rater reliability of the MARM were calculated. Results“Very good” inter-rater and intra-rater reliability were found with the MARM values during both normal and deep breathing patterns. (Inter-rater: ICC range = 0.71 to 0.82; intra-rater: ICC range = 0.72 to 0.80). ConclusionsMARM is a reliable clinical and research tool for assessing breathing patterns with very good inter- and intra-rater reliability in patients with unilateral cervical radiculopathy.

Comparing outcomes between anterior cervical disc replacement (ACDR) and minimally invasive posterior cervical foraminotomy (MI-PCF) in the treatment of cervical radiculopathy

BACKGROUND CONTEXTAnterior cervical disc replacement (ACDR) and minimally invasive posterior cervical foraminotomy (MI-PCF) have emerged as two increasingly popular alternatives to anterior cervical discectomy and fusion (ACDF) for the management of cervical radiculopathy. Both techniques provide advantages of segmental motion preservation and lower rates of adjacent segment degeneration (ASD) compared to ACDF. PURPOSEThe purpose of this study was to analyze the clinical and functional outcomes of patients undergoing ACDR or MI-PCF for the treatment of unilateral cervical radiculopathy. STUDY DESIGN/SETTINGRetrospective Cohort Review. PATIENT SAMPLEA total of 152 patients were included (86 ACDR and 66 MI-PCF). OUTCOME MEASURES(1) Patient demographics; (2) perioperative data; (3) rates of complications and revisions; (5) visual analogue scale (VAS) and Neck Disability Index (NDI) scores. METHODSA retrospective cohort review was performed to identify all patients at a single institution between 2012-2020 who underwent 1- or 2- level ACDR or MI-PCF from C3-C7 with a minimum follow-up of 24 months. Patient demographics, perioperative data, postoperative complications, and revisions were analyzed. Patient reported outcome measures including VAS and NDI scores were compared. RESULTSThe ACDR group had a significantly greater mean operative time (99.8 minutes vs 79.2 minutes, p<.001), but comparable estimated blood loss and length of stay following surgical intervention (p=.899). The overall complication rate was significantly greater in the ACDR group than the MI-PCF group (24.4% vs 6.2%; p=.003) but was largely driven by approach-related dysphagia in 20.9% of ACDR patients. The MI-PCF group had significantly greater revision rates (13.6% vs 1.2%; p=.002) with an average time to revision of 20.7 months in the MI-PCF group compared to 40.3 months in the ACDR group. The ACDR cohort had significantly greater improvements in NDI scores at the final follow-up (25.0 vs 21.3, p<.001). ConclusionOur results suggest that ACDR offer clinically relevant advantages over MI-PCF in terms of long-term revision rates despite an increased approach-related risk of transient postoperative dysphagia. Additionally, patients in the ACDR cohort achieved greater mean improvements in NDI scores but these results may have limited clinical significance due to inability to reach minimally clinically important difference (MCID) thresholds.

Effects of myofascial release technique in patients with unilateral cervical radiculopathy: A single blind-randomized clinical trial

ObjectiveThe aim of this study was to investigate the effectiveness of the myofascial release technique in individuals diagnosed with unilateral cervical radiculopathy. Materials and methodsThirty-four cervical radiculopathy patients were randomly assigned to either the myofascial release group or the exercise group. Both groups received conventional treatment. Additionally, the exercise group performed stretching and strengthening exercises while the myofascial release group received the myofascial release technique. The pain pressure threshold, muscle strength, cervical range of motion, pain, and disability variables were assessed for all patients. ResultsThe myofascial release group demonstrated significantly larger improvements in flexion (p = 0.001), extension (p = 0.037), left rotation (p = 0.012), and left lateral flexion (p = 0.001) range of motions compared to the exercise group. Muscle strength in the wrist flexors (p < 0.001), wrist extensors (p < 0.010), biceps (p < 0.001) and triceps (p < 0.001) were significantly higher in the myofascial release group compared to the exercise group. And, again, the myofascial release group demonstrated significantly larger improvements in wrist flexors (p < 0.001), wrist extensors (p < 0.001), biceps (p < 0.001), triceps (p < 0.001), pectorals (p < 0.001), subscapularis (p < 0.001), upper trapezius (p = 0.002), and the pain pressure threshold. Finally, the myofascial release group demonstrated statistically significant improvements in pain (p < 0.001) and disability (p < 0.001) scales compared to the exercise group. ConclusionEvaluation of the arm muscle strength and pain pressure threshold variables in patients with cervical radiculopathy may benefit clinicians in the preparation of treatments. Cervical radiculopathy symptoms may improve after the application of myofascial release techniques. A customized cervical exercise program and conventional treatment could be added to the non-surgical treatment of cervical radiculopathy.

Comparison of breathing pattern and diaphragmatic motion in patients with unilateral cervical radiculopathy and asymptomatic group

BackgroundThe associations between neck pain and respiratory dysfunction were clarified in patients with neck pain. There is dearth of evidence on pulmonary dysfunction and diaphragmatic excursion in patients with unilateral cervical radiculopathy (CR). The purpose of this study was to compare the breathing pattern and diaphragmatic excursion in patients with unilateral CR with those in an asymptomatic group.MethodsTwenty-five patients with unilateral CR and 25 asymptomatic individuals aged between 30 and 55 participated in this study. Diaphragmatic motion, breathing pattern, active cervical range of motion and kinesiophobia were investigated in both groups by using fluoroscopy, manual assessment of respiratory motion (MARM), cervical range of motion device, and Tampa scale of kinesiophobia. Statistical significance was set at 0.05.ResultsNo statistically significant differences were found between the two groups with regard to sex, age and body mass index. The mean excursion of the hemi diaphragm on the involved side (the side of CR) was significantly lower than that on the uninvolved side in patients with unilateral CR with a large effect size. The excursion of the involved hemi diaphragm in patients was reduced compared to the matched hemi diaphragm in the control group. There was no significant difference between the hemi diaphragms excursion in the control group. The results of the MARM variables showed that the volume of breathing and the percentage rib cage motion in normal and deep breathing were significantly different between the two groups, but there was no significant difference in the balance of breathing between the two groups. Additionally, the active cervical range of motion was reduced in these patients in comparison to the control group, and it was less on the involved side than on the uninvolved side.ConclusionThe results of this study revealed a dysfunctional breathing pattern in normal and deep breathing and a unilateral reduction in diaphragmatic excursion on the side of radiculopathy in patients with unilateral CR compared to the control group.

Optimization of Muscle Selection for Needle Electromyography in Isolated C6 Root Lesion: A Prospective Chart Review Study.

The aim of the study is to evaluate muscles with more prominent needle electromyographic findings to optimize needle electromyography screening of isolated C6 radiculopathy in patients with C6 root lesions. This prospective clinical study was performed on 39 patients with isolated and unilateral cervical radiculopathy selected from all referrals of 1733 patients to the electrodiagnosis unit of the physical medicine and rehabilitation department of a tertiary medical center (from April 2021 to December 2021). The presence of fibrillation potentials, positive sharp waves, and/or neurogenic motor action potentials that occurred in isolation or combination with selected muscles was considered an abnormal finding. Of 1733 referrals, 39 patients (18 males [46.1%] and 21 females [53.8%]), with a mean age of 49.7 ± 9.6 yrs, were found eligible. According to needle electromyography findings, the most involved muscles in C6 root lesion were pronator teres (100%), followed by extensor carpi radialis longus (94.8%), flexor carpi radialis (89.7%), brachioradialis (82%), infraspinatus (82%), supraspinatus (79.4%), deltoid (74.3%), biceps brachii (64.1%), extensor digitorum communis (33.3%), and triceps brachii (15.3%) muscles. The pronator teres is the most involved muscle of patients diagnosed with C6 radiculopathy. It might be considered the key muscle for screening and accurate diagnosis of C6 root involvement.

Comparison of Load-Sharing Responses Between Graded Posterior Cervical Foraminotomy and Conventional Fusion Using Finite Element Modeling.

Following the diagnosis of unilateral cervical radiculopathy and need for surgical intervention, anterior cervical diskectomy and fusion (conventional fusion) and posterior cervical foraminotomy are common options. Although patient outcomes may be similar between the two procedures, their biomechanical effects have not been fully compared using a head-to-head approach, particularly, in relation to the amount of facet resection and internal load-sharing between spinal segments and components. The objective of this investigation was to compare load-sharing between conventional fusion and graded foraminotomy facet resections under physiological loading. A validated finite element model of the cervical spinal column was used in the study. The intact spine was modified to simulate the two procedures at the C5-C6 spinal segment. Flexion, extension, and lateral bending loads were applied to the intact, graded foraminotomy, and conventional fusion spines. Load-sharing was determined using range of motion data at the C5-C6 and immediate adjacent segments, facet loads at the three segments, and disk pressures at the adjacent segments. Results were normalized with respect to the intact spine to compare surgical options. Conventional fusion leads to increased motion, pressure, and facet loads at adjacent segments. Foraminotomy leads to increased motion and anterior loading at the index level, and motions decrease at adjacent levels. In extension, the left facet load decreases after foraminotomy. Recognizing that foraminotomy is a motion preserving alternative to conventional fusion, this study highlights various intrinsic biomechanical factors and potential instability issues with more than one-half facet resection.

Contralateral Inside-out Biportal Endoscopic Posterior Cervical Foraminotomy: Surgical Techniques and Preliminary Clinical Outcomes

Objective: The aim of this study was to describe the surgical techniques and preliminary results of inside-out biportal endoscopic posterior cervical foraminotomy (BEPCF) for unilateral cervical radiculopathy.Methods: This study involved 36 consecutive patients (38 segments) who underwent BEPCF for unilateral cervical radiculopathy between November 2020 and June 2022. Foraminotomy was performed using the biportal endoscopic technique, with the surgeon standing on the opposite side and making skin incisions on the same side of the foramen stenosis. After widening of the V-point and exposing the nerve root using a high-speed drill, we used a curved osteotome to undercut the facet joint from inside the foramen to complete the nerve root decompression. Results: The study followed patients for an average of 15.5 months and found significant improvements in the visual analog scale for arm pain, from 7.3 ± 2.2 to 0.9 ± 0.7 (P &lt; 0.005), and the Neck Disability Index, from 54.6 ± 16.9 to 14.6 ± 12.6 (P &lt; 0.005). Almost all patients (94.4%) had good or excellent results. Hospitalization lasted an average of 3.2 days and postoperative magnetic resonance imaging showed successful neural decompression. Complications were minimal, with only two cases of asymptomatic root abrasions and one case of transient neuralgia. One patient required re-operation due to incomplete decompression.Conclusion: BEPCF is a safe and effective surgical technique for treating cervical radiculopathy. The surgeon can achieve good neural decompression and preserve the facet joint using the inside-out approach in an ergonomic setting.

Commentary: Anterior Cervical Discectomy and Fusion Versus Microendoscopic Posterior Cervical Foraminotomy for Unilateral Cervical Radiculopathy: A 1-Year Cost-Utility Analysis.

Department of Neurosurgery, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA Correspondence: Robert G. Whitmore, MD, Department of Neurosurgery, Lahey Hospital & Medical Center, 41 Mall Rd, 7 Central, Burlington, MA01805, USA. Email: [email protected]

367 Microendoscopic Posterior Cervical Foraminotomy in the Ambulatory Setting: A Longitudinal Experience

INTRODUCTION: Posterior cervical foraminotomy (PCF) is a motion-sparing surgical option for unilateral cervical radiculopathy caused by foraminal stenosis. The evolution of microendoscopic (MED) techniques makes it an ideal procedure for the outpatient setting. There are few studies to date that report the safety and efficacy of this procedure specifically in the ambulatory setting. METHODS: This study was a retrospective case series of all patients who underwent MED-PCF at a single ambulatory surgery center over a 6-year period. Standard demographic and perioperative data were collected. Outcome measures included visual analog scale (VAS) pain scores, postoperative complications, 30-day readmission, and need for reoperation at the index or adjacent levels. RESULTS: A total of 825 patients underwent MED-PCF during the 6-year study period. Mean age was 56.5 years. Most patients underwent decompression at C5-6 (260, 31.5%) or C6-7 (426, 51.6%). Eighty-five patients (10.3%) underwent surgery at multiple levels. Mean operative time was 38.0 minutes for single-level cases and 53.1 minutes for multilevel cases. There were no intraoperative or immediate postoperative complications. All patients were discharged home with an approximate length of stay of 3 hours (mean 182.7 ± 44.8 minutes). The vast majority of patients (85.7%) experienced improved VAS pain scores postoperatively and achieved a good or excellent clinical outcome (75.8%) according to the Odom criteria. Almost half (43.5%) had complete resolution of their preoperative pain (ie. postoperative VAS pain score of 0). Very few patients (5, 0.6%) were readmitted within 30 days. Only 46 patients (5.6%) required reoperation at the index level (35, 4.2%), adjacent level (16, 1.9%), or both (5, 0.6%). Mean follow-up was 13.4 months. CONCLUSIONS: MED-PCF can be performed safely in the ambulatory setting with excellent efficacy and low reoperation rates.

366 Micro-Endoscopic Posterior Cervical Foraminotomy and Discectomy is Health Economically Dominant to Anterior Cervical Discectomy and Fusion for Unilateral Cervical Radiculopathy

INTRODUCTION: Micro-endoscopic posterior cervical foraminotomy and discectomy (MPCF) has served as a minimally invasive, motion sparing alternative to ACDF for unilateral cervical radiculopathy for decades. While growing data suggests similar effectiveness, the cost effectiveness and potentially superior healthcare value of MPCF vs ACDF remains largely unstudied. METHODS: The National Quality Outcomes Database (QOD) was queried for 323 consecutive ASA 1-3 patients (201 ACDF, 122 MPCF) performed at the authors' single institution for unilateral cervical radiculopathy at our ambulatory surgical center (ASC). Propensity-matching yielded 222 patients. Resource utilization, missed workdays, and EQ5D quality adjusted life year (QALY) gains were assessed over a one-year period. Direct cost (resource use x unit costs based on Medicare national allowable payment amounts) and indirect cost (missed workdays x average US daily wage) were recorded and incremental cost-effectiveness ratio (ICER) was calculated. RESULTS: Estimated blood loss, and length of surgery were less for MPCF vs. ACDF (p &lt; 0.001). All other safety measures and patient-reported outcomes were similar between cohorts. MPCF vs. ACDF demonstrated reduction in total one-year costs of $6,709 (Medicare) and $13,061 (private payers) (p &lt; 0.001), and comparable QALYs gained. ACDF vs. MPCF had a cost ineffective ICER of $91,773/QALY-gained and $178,668/QALY for Medicare and private payer patients, respectively. CONCLUSIONS: MPCF is a health-economically dominant option to ACDF for unilateral cervical radiculopathy given the increased healthcare costs despite comparable safety, outcome, and QALY gains associated with ACDF.

Anterior Cervical Discectomy and Fusion Versus Microendoscopic Posterior Cervical Foraminotomy for Unilateral Cervical Radiculopathy: A 1-Year Cost-Utility Analysis.

Anterior cervical discectomy and fusion (ACDF) and posterior cervical foraminotomy (PCF) are the most common surgical approaches for medically refractory cervical radiculopathy. Rigorous cost-effectiveness studies comparing ACDF and PCF are lacking. To assess the cost-utility of ACDF vs PCF performed in the ambulatory surgery center setting for Medicare and privately insured patients at 1-year follow-up. A total of 323 patients who underwent 1-level ACDF (201) or PCF (122) at a single ambulatory surgery center were compared. Propensity matching generated 110 pairs (220 patients) for analysis. Demographic data, resource utilization, patient-reported outcome measures, and quality-adjusted life-years were assessed. Direct costs (1-year resource use × unit costs based on Medicare national allowable payment amounts) and indirect costs (missed workdays × average US daily wage) were recorded. Incremental cost-effectiveness ratios were calculated. Perioperative safety, 90-day readmission, and 1-year reoperation rates were similar between groups. Both groups experienced significant improvements in all patient-reported outcome measures at 3 months that was maintained at 12 months. The ACDF cohort had a significantly higher preoperative Neck Disability Index and a significantly greater improvement in health-state utility (ie, quality-adjusted life-years gained) at 12 months. ACDF was associated with significantly higher total costs at 1 year for both Medicare ($11 744) and privately insured ($21 228) patients. The incremental cost-effectiveness ratio for ACDF was $184 654 and $333 774 for Medicare and privately insured patients, respectively, reflecting poor cost-utility. Single-level ACDF may not be cost-effective in comparison with PCF for surgical management of unilateral cervical radiculopathy.

Comparison of Single-level Cervical Radiculopathy Outcomes Between Posterior Endoscopic Cervical Decompression and Anterior Cervical Discectomy and Fusion: Mid-term Results.

A retrospective cohort study. To investigate the mid-term results and technical possibilities of posterior endoscopic cervical decompression (PECD) in the treatment of cervical radiculopathy. PECD has been used in the treatment of cervical radiculopathy for the past decades; there is a paucity of studies directly comparing its outcomes with anterior cervical discectomy and fusion (ACDF) for patients with single-level cervical radiculopathy. From January 2016 to December 2018, clinical and radiologic data of 42 patients were collected. Patients were followed for a mean of 40.6 months (range: 30-54 mo) after surgery. Changes in cervical lordosis and degeneration of adjacent segments were analyzed. Dysphagia was assessed using the Bazaz score, and clinical outcomes were analyzed using the Neck Disability Index and visual analog scoring system. There were no significant differences in neurological outcomes between the two groups. Significant between-group differences in postoperative dysphagia were observed ( P < 0.05). There were significant differences in postoperative segmental Cobb angles and disc height between the two groups ( P < 0.05). Degenerative changes in the adjacent segments occurred in 5 patients in the ACDF group and 1 patient in the PECD group ( P < 0.05); no revision surgery was needed. Clinical outcomes of PECD for patients with unilateral radiculopathy were satisfactory. On the premise of a strict selection of indications, we consider this technique to be a safe supplement and alternative to ACDF for patients with unilateral cervical radiculopathy. Longer follow-up periods are required to confirm these observations.

Combined cervical laminoplasty and foraminotomy for coexistence of cervical myelopathy and unilateral radiculopathy: case series and preliminary results.

The clinical outcomes and radiographic changes of a one-stage procedure combining cervical laminoplasty and unilateral cervical foraminotomy for patients with coexisting cervical myelopathy and unilateral radiculopathy were evaluated. Seven patients (two females and five males) with coexisting cervical myelopathy and unilateral cervical radiculopathy were included in this study. The mean age was 58.4years (range 45-77years). Cervical laminoplasty and unilateral cervical foraminotomy were performed on the recruited patients in a single stage. The quantitative clinical changes between the preoperative and 6-month postoperative assessment were analyzed using the Japanese Orthopedic Association (JOA) score, the JOA Cervical Myelopathy Evaluation Questionnaire (JOA-CMEQ), visual analog scale (VAS), and Neck Disability Index (NDI). Moreover, the preoperative and 6-month postoperative radiographic changes were assessed using the C2-7 angle and range of motion (ROM) between flexion and extension angle. There were significant differences in QOL in the JOA-CMEQ between the groups. Furthermore, the postoperative VAS values in the arms and hands generally improved, although not significantly, between the groups. The aforementioned surgical procedure may be safe and efficient for patients with coexisting cervical myelopathy and radiculopathy.

Feasibility and Safety of Microendoscopic Posterior Cervical Foraminotomy in an Ambulatory Surgery Center: A Longitudinal Experience with 1000 Cases

Ambulatory surgery centers (ASCs) have become an increasingly attractive setting for spine surgery in recent decades. Although posterior cervical foraminotomy (PCF) is widely performed in ASCs, there are no studies supporting the safety of this practice. We aimed to demonstrate the feasibility and safety of microendoscopic (MED)-PCF in a large cohort of patients at a freestanding ASC. Consecutive patients undergoing MED-PCF for unilateral cervical radiculopathy at a single freestanding ASC from January 2013 to December 2020 were queried. Standard demographic and perioperative data were collected. Outcomes included need for inpatient transfer, perioperative complications, 30-day readmission, 30-day reoperation, and clinical improvement according to the Odom criteria. A total of 1106 patients underwent MED-PCF during the study period. Mean age was 53.3 ± 10.3 years. Most patients underwent decompression at C5-6 (31.4%) or C6-7 (51.9%). Approximately 10% underwent surgery at multiple levels. Mean operative time was 40.0 ± 16.4 minutes. There were no intraoperative or immediate postoperative complications. All patients were discharged home within a few hours of surgery. The rates of 30-day readmission (0.81%) and reoperation (0.36%) were exceedingly low. Nearly 3 quarters of patients (73.7%) achieved a good or excellent clinical outcome (73.7%) according to the Odom criteria. MED-PCF can be performed in a freestanding ASC with exceedingly low rates of perioperative complications and short-term readmission or reoperation. Our findings support the ongoing migration of PCF from the hospital to the ambulatory setting. Future studies assessing patient-reported outcomes and long-term reoperation rates are necessary.

Comparative Study of Anterior Transvertebral Foraminotomy and Anterior Cervical Discectomy and Fusion for Unilateral Cervical Spondylotic Radiculopathy

To study the compared surgical and radiographic outcomes of Transvertebral foraminotomy (TVF) with anterior cervical discectomy and fusion (ACDF) in patients with unilateral cervical spondylotic radiculopathy (CSR). We performed a retrospective comparative study of 72 consecutive patients with 1- or 2-level CSR treated with ACDF or TVF. 27 patients who underwent TVF (group T) and 45 patients who underwent ACDF (group A) with a minimum 2-year follow-up were enrolled. We evaluated clinical outcomes and radiological assessment. Clinical outcome included Visual analog scale (VAS) scores for axial, arm pain at preoperatively and final follow-up. VAS score for painful swallowing was also evaluated 1week after surgery. Radiological assessment included C2-7 sagittal Cobb angle (C2-7 CA), range of motion (ROM) of C2-7 CA, the height, angle and ROM of the functional spinal unit (FSU), and tip of the spinous process of the operated segment. We also evaluated the disc height, FSU angle, and ROM of the FSU at the cranial adjacent segment. Both groups had good clinical outcomes. Soft tissue swelling was significantly less prominent in group T than that for group A. VAS scores for painful swallowing is lower in group T without significant difference. The ROM of C2-7 CA, FSU, and spinous processes demonstrated a significant reduction in group A compared with group T.(P < 0.05). Disc height at the cranial adjacent segment was maintained in group T. TVF is as effective as ACDF for unilateral CSR and preserves whole cervical spine and segmental alignment.

Minimally invasive posterior cervical foraminotomy versus anterior cervical discectomy and fusion for cervical radiculopathy: a meta-analysis.

With the recent development of minimally invasive techniques, minimally invasive posterior cervical foraminotomy (MIS-PCF) has become increasingly popular as a minimally invasive method to treat cervical radiculopathy. However, there are still controversies about whether MIS-PCF is superior to anterior cervical discectomy and fusion (ACDF). The purpose of this study is to evaluate the therapeutic effects of MIS-PCF and ACDF on unilateral cervical radiculopathy without myelopathy. We searched PubMed, Embase, the Cochrane Library, and Scopus comprehensively using the terms related to MIS-PCF. Two reviewers independently evaluated the potential studies, and extracted and analyzed the data of operation time, hospital stay, neck disability index (NDI) score, visual analog scale for neck pain (VAS-neck) and arm pain (VAS-arm) scores, reoperation rate, and complications. Seven studies with 1175 patients were included. The study population was 53.5% male, with a mean age of 48.9. MIS-PCF presented a significantly shorter postoperative hospitalization time compared to ACDF, while the operation time, complication/reoperation rate, and VAS-arm, VAS-neck, and NDI scores were comparable between the two cohorts. In North America, the average cost of MIS-PCF is lower than ACDF. Thus, we suggest that MIS-PCF is an alternative to ACDF for selected patients.

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

<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.

Comparison of Percutaneous Endoscopic Cervical Keyhole Foraminotomy versus Microscopic Anterior Cervical Discectomy and Fusion for Single Level Unilateral Cervical Radiculopathy.

ObjectiveTo compare the clinical and radiological outcomes between microscopic anterior cervical discectomy and fusion (ACDF) and percutaneous endoscopic cervical keyhole foraminotomy (PECF) for single level unilateral cervical radiculopathy.MethodsA total of 127 patients (59 in PECF VS 68 in ACDF) were enrolled in this study from April 2016 to May 2018 with a minimum follow-up of 2 years. Clinical data including baseline data, Neck Disability Index (NDI), and Visual Analogue Scale for neck and arm (VAS-n, VAS-a) were collected and compared. Radiological evaluation such as disc height, ROM of cervical, Cobb’s angle of cervical and Cobb’s angle of operated segment was measured by two experienced radiologists in twice.ResultsThere was no significant difference between the two groups in the baseline data, and hospital stay was significantly decreased in PECF group than ACDF group (P < 0.001). PECF group did not yield superior better outcomes in NDI, VAS-a and VAS-n than ACDF group except at 1-month follow-up. As for radiological outcomes, PECF group has significantly better cervical motion, cervical angle and segmental angle than ADCF group at 12- and 24-month follow-up visit (P < 0.05); however, ACDF had shown better disc height restoration and maintenance than PECF (P < 0.05). More complications including surface hematoma and swallowing difficulty were occurred in ADCF group.ConclusionPercutaneous endoscopic cervical keyhole foraminotomy could be the alternative method for anterior cervical discectomy and fusion in selective cases. However, the indication should be fulfilled, more studies need to be conducted to further testify the efficacy of PECF.

Surgical Treatment of Single Level Cervical Radiculopathy: A Comparison of Anterior Cervical Decompression and Fusion (ACDF) Versus Cervical Disk Arthroplasty (CDA) Versus Posterior Cervical Foraminotomy (PCF).

This was a retrospective cohort study. The objective of this study is to retrospectively compare the clinical outcomes, complication rates, and reoperation rates among the 4 treatments in patients with cervical radiculopathy. Surgical options for cervical radiculopathy include anterior cervical discectomy and fusion (ACDF), open posterior cervical foraminotomy (O-PCF), minimally invasive posterior cervical foraminotomy (MI-PCF), and cervical disk arthroplasty (CDA). Retrospective chart review after Review Board approval. Of the 384 patients in the study-257 ACDF, 18 O-PCF, 52 MI-PCF, and 56 CDA. Information was obtained from the charts and compared between the groups. Patients above 18 years of age with single-level, unilateral cervical radiculopathy correlating with magnetic resonance imaging, failure of nonoperative management, and 1-level ACDF, O-PCF, MI-PCF, or CDA with >24 months of follow-up. Neck Disability Index (NDI), Visual Analog Score neck and arm pain, minimum clinically significant difference (MCID), complication rates, and reoperation rates. Operative time was significantly shorter for MI-PCF. Median estimated blood loss was small, but greater with O-PCF compared with other interventions. The length of hospital stay was longest for the ACDF group. At 2 years' follow-up, 36 subjects (9%) had subsequent neck surgery. The most common indication for additional surgery was recurrent symptoms (3.4%) followed by adjacent segment disease (2.6%), pseudoarthrosis (2.1%), adjacent segment disease + pseudoarthrosis (0.5%), and implant-related complications (0.3%). There was no statistically significant difference in complication rates between groups. MCID in NDI was achieved in 40% of MI-PCF subjects, 42% of O-PCF subjects, 66% of CDA subjects and 46% of ACDF subjects. All 4 treatment options confer good clinical results on patients for cervical radiculopathy. Intraoperative and postoperative complications were low and comparable in all 4 groups. MI-PCF had the shortest surgical time and length of hospital stay. More CDA patients achieved MCID in NDI compared with the others, and the rate for additional surgery at 2 years was lowest in the CDA group.