To Örebro University

Cervical radiculopathy is the most frequent condition of the cervical spine. Operative treatment is a commonly performed when nonsurgical treatment fails. The main cause of cervical radiculopathy is degenerative disease of the spine, leading to foraminal stenosis and ultimately a nerve-root impingement. Often patients ask about the heredity of their condition, but no clear answers can be given. The controversy is in the choice of operative treatment, conducting either Anterior Cervical Decompression and Fusion (ACDF) or Posterior Foraminotomy (PF). Both methods have been around since the late 1950’s but despite this, evidence is still lacking to confirm superiority of either method. The objective of this thesis is to ascertain the outcomes of ACDF and PF as well as the hereditary factors for requiring surgery. We used the Swespine registry to ascertain the clinical outcomes of surgery for CR, subsequently, by using pseudo-randomization we evaluated the patient reported outcomes and reoperation rates between ACDF and PF. Our results revealed that both methods have equal clinical outcomes at 1,2- and 5-years of follow-up. We showed higher reoperation rate for PF than ACDF at index level. Subsequently, we could move forward in creating a multicentre randomized controlled trial with ACDF as control, and PF as intervention with a non-inferiority design. A study protocol was designed using the reporting guidelines for clinical trials and published. Thus, Örebro Multicentre Study on Operative Treatment of Cervical Radiculopathy: Anterior Cervical Decompression and Fusion Versus Posterior Foraminotomy (OMSAP) was born and the study started in 2020. Interim analysis after 5-years of recruiting concludes higher reoperation rates for PF and statistically non-significant outcomes in favour of ACDF, no severe adverse events have been found in the analysis. Finally, we used the Swespine registry and the Twin registry to ascertain the hereditary factors for the surgical phenotype by examining the operation rates in 145 twins for cervical degenerative diseases. We conclude that the probability for hereditary factor for surgically treated diseases is low.