Posterior cervical foraminotomy compared with anterior cervical discectomy and fusion for one and two level cervical radiculopathy: a matched cohort analysis utilizing PROMIS.

Introduction: Both posterior cervical foraminotomy (PCF) and anterior cervical discectomy and fusion (ACDF) have been used to treat cervical radiculopathy. Surgeons debate which procedure is superior, citing impact on neck pain, recovery time, expense, and revision surgery rate as potential differentiating factors between the procedures. This is the first study to utilize Patient-Reported Outcomes Measurement Information System (PROMIS) results across PCF and ACDF for unilateral radiculopathy.

Methods: Patients undergoing ACDF were matched to patients undergoing PCF across age, sex, spinal level, comorbidity, BMI, smoking status, and PROMIS pain, physical function, and depression scores. PROMIS scores, revision rates, complications, numeric pain scores, and physical exam findings of weakness and sensory loss were assessed postoperatively and compared between ACDF and PCF. Implant costs of ACDFs were obtained from operative notes.

Results: 32 PCF and 32 ACDF patients were compared with no differences found in preoperative age, sex, spinal level, comorbidity, BMI, smoking status, and PROMIS pain, physical function, and depression scores. Mean follow-up was 399. 59 (SD 448.84) days and 181.72 (SD 234.26) days for ACDF and PCF respectively (p <.019). Postoperative results for both groups showed improvement in PROMIS pain, physical function, and depression scores after 10 weeks with no statistical differences noted between ACDF and PCF (p>0.05). Mean implant costs to the hospital were $1,836.37 and $2,773.44 for one and two level ACDFs respectively.

Conclusion : Patients with unilateral cervical radiculopathy can expect similar clinical outcomes receiving PCF compared to ACDF; however, PCF poses advantageous as it is less invasive and less costly due to the lack of required implants.