PMID- 38185140 OWN - NLM STAT- MEDLINE DCOM- 20240426 LR - 20240426 IS - 1878-1632 (Electronic) IS - 1529-9430 (Linking) VI - 24 IP - 5 DP - 2024 May TI - Comparing outcomes between anterior cervical disc replacement (ACDR) and minimally invasive posterior cervical foraminotomy (MI-PCF) in the treatment of cervical radiculopathy. PG - 800-806 LID - S1529-9430(24)00003-2 [pii] LID - 10.1016/j.spinee.2023.12.010 [doi] AB - BACKGROUND CONTEXT: Anterior 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. PURPOSE: The 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/SETTING: Retrospective Cohort Review. PATIENT SAMPLE: A 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. METHODS: A 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. RESULTS: The 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). CONCLUSION: Our 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. CI - Copyright (c) 2024 Elsevier Inc. All rights reserved. FAU - Changoor, Stuart AU - Changoor S AD - Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, 07503 USA. FAU - Farshchian, Joseph AU - Farshchian J AD - Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, 07503 USA. FAU - Patel, Neil AU - Patel N AD - Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, 07503 USA. FAU - Coban, Daniel AU - Coban D AD - Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, 07503 USA. FAU - Abdelmalek, George AU - Abdelmalek G AD - Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, 07503 USA. FAU - Sinha, Kumar AU - Sinha K AD - Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, 07503 USA. FAU - Hwang, Ki AU - Hwang K AD - Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, 07503 USA. FAU - Emami, Arash AU - Emami A AD - Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, 07503 USA. Electronic address: emamiresearch@gmail.com. LA - eng PT - Comparative Study PT - Journal Article DEP - 20240105 PL - United States TA - Spine J JT - The spine journal : official journal of the North American Spine Society JID - 101130732 SB - IM MH - Humans MH - *Radiculopathy/surgery MH - Male MH - Female MH - Middle Aged MH - *Foraminotomy/methods MH - *Cervical Vertebrae/surgery MH - Retrospective Studies MH - *Total Disc Replacement/methods/adverse effects MH - Adult MH - Treatment Outcome MH - *Minimally Invasive Surgical Procedures/methods MH - Spinal Fusion/methods/adverse effects MH - Aged MH - Diskectomy/methods/adverse effects MH - Postoperative Complications/epidemiology/etiology OTO - NOTNLM OT - Cervical disc arthroplasty OT - Cervical disc replacement OT - Complications OT - Minimally invasive spine surgery OT - Outcomes OT - Posterior cervical foraminotomy, Cervical radiculopathy COIS- Declaration of competing interest One or more of the authors declare financial or professional relationships on ICMJE-TSJ disclosure forms. EDAT- 2024/01/08 00:42 MHDA- 2024/04/27 09:50 CRDT- 2024/01/07 19:13 PHST- 2023/10/17 00:00 [received] PHST- 2023/11/27 00:00 [revised] PHST- 2023/12/27 00:00 [accepted] PHST- 2024/04/27 09:50 [medline] PHST- 2024/01/08 00:42 [pubmed] PHST- 2024/01/07 19:13 [entrez] AID - S1529-9430(24)00003-2 [pii] AID - 10.1016/j.spinee.2023.12.010 [doi] PST - ppublish SO - Spine J. 2024 May;24(5):800-806. doi: 10.1016/j.spinee.2023.12.010. Epub 2024 Jan 5.