Posterior foraminotomy versus anterior decompression and fusion in patients with cervical degenerative disc disease with radiculopathy: up to 5 years of outcome from the national Swedish Spine Register

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OBJECTIVE

The long-term efficacy of posterior foraminotomy compared with anterior cervical decompression and fusion (ACDF) for the treatment of degenerative disc disease with radiculopathy has not been previously investigated in a population-based cohort.

METHODS

All patients in the national Swedish Spine Register (Swespine) from January 1, 2006, until November 15, 2017, with cervical degenerative disc disease and radiculopathy were assessed. Using propensity score matching, patients treated with posterior foraminotomy were compared with those undergoing ACDF. The primary outcome measure was the Neck Disability Index (NDI), a patient-reported outcome score ranging from 0% to 100%, with higher scores indicating greater disability. A minimal clinically important difference was defined as > 15%. Secondary outcomes were assessed with additional patient-reported outcome measures (PROMs).

RESULTS

A total of 4368 patients (2136/2232 women/men) met the inclusion criteria. Posterior foraminotomy was performed in 647 patients, and 3721 patients underwent ACDF. After meticulous propensity score matching, 570 patients with a mean age of 54 years remained in each group. Both groups had substantial decreases in their NDI scores; however, after 5 years, the difference was not significant (2.3%, 95% CI −4.1% to 8.4%; p = 0.48) between the groups. There were no significant differences between the groups in EQ-5D or visual analog scale (VAS) for neck and arm scores. The secondary surgeries on the index level due to restenosis were more frequent in the foraminotomy group (6/100 patients vs 1/100), but on the adjacent segments there was no difference between groups (2/100).

CONCLUSIONS

In patients with cervical degenerative disc disease and radiculopathy, both groups demonstrated clinical improvements at the 5-year follow-up that were comparable and did not achieve a clinically important difference from one another, even though the reoperation rate favored the ACDF group. This study design obtains population-based results, which are generalizable.

ABBREVIATIONS ACDF = anterior cervical decompression and fusion; MCID = minimal clinically important difference; NDI = Neck Disability Index; PROM = patient-reported outcome measure; Swespine = Swedish Spine Register; VAS = visual analog scale.
Article Information

Contributor Notes

Correspondence Anna MacDowall: Uppsala University Hospital, Uppsala, Sweden. anna.mac.dowall@akademiska.se.INCLUDE WHEN CITING Published online November 15, 2019; DOI: 10.3171/2019.9.SPINE19787.Disclosures Dr. Heary: royalties from Zimmer Spine and Thieme Medical Publishers, president of the Lumbar Spine Research Society, and vice president of the American Association of Neurological Surgeons. Dr. Olerud: paid speaker for Johnson & Johnson; speakers bureau of Anatomica, AOSpine, DePuy Synthes, and Medtronic; and board member of Cervical Spine Research Society Europe.
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