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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
Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.
Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark New Jersey, USA.
Örebro University, School of Medical Sciences. Department of Orthopedics, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0002-3905-7210
Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
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2020 (English)In: Journal of Neurosurgery: Spine, ISSN 1547-5654, E-ISSN 1547-5646, Vol. 32, no 3, p. 344-352Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
American Association of Neurological Surgeons , 2020. Vol. 32, no 3, p. 344-352
Keywords [en]
posterior foraminotomy, anterior decompression and fusion, surgical outcome, Neck Disability Index, cervical radiculopathy, degenerative
National Category
Neurology Surgery
Identifiers
URN: urn:nbn:se:oru:diva-80852DOI: 10.3171/2019.9.SPINE19787ISI: 000518390200002PubMedID: 31731263OAI: oai:DiVA.org:oru-80852DiVA, id: diva2:1416965
Available from: 2020-03-26 Created: 2020-03-26 Last updated: 2020-03-26Bibliographically approved

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