Comparing Outcomes Between Anterior Cervical Disc Replacement (ACDR) and Minimally Invasive Posterior Cervical Foraminotomy (MI-PCF) in the Treatment of Cervical Radiculopathy.
Cervical disc replacement
cervical disc arthroplasty
minimally invasive spine surgery
posterior cervical foraminotomy, cervical radiculopathy
Journal
The spine journal : official journal of the North American Spine Society
ISSN: 1878-1632
Titre abrégé: Spine J
Pays: United States
ID NLM: 101130732
Informations de publication
Date de publication:
05 Jan 2024
05 Jan 2024
Historique:
received:
17
10
2023
revised:
27
11
2023
accepted:
27
12
2023
medline:
8
1
2024
pubmed:
8
1
2024
entrez:
7
1
2024
Statut:
aheadofprint
Résumé
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. 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. Retrospective Cohort Review PATIENT SAMPLE: 152 patients were included (86 ACDR and 66 MI-PCF). 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 Visual analogue scale (VAS) and Neck Disability Index (NDI) scores were compared. The ACDR group had a significantly greater mean operative time (99.8 minutes vs 79.2 minutes, p<0.001), but comparable estimated blood loss and length of stay following surgical intervention (p=0.899). The overall complication rate was significantly greater in the ACDR group than the MI-PCF group (24.4% vs 6.2%; p=0.003) 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=0.002) 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<0.001). 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.
Sections du résumé
BACKGROUND CONTEXT
BACKGROUND
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
OBJECTIVE
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
METHODS
Retrospective Cohort Review PATIENT SAMPLE: 152 patients were included (86 ACDR and 66 MI-PCF).
OUTCOME MEASURES
METHODS
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 Visual analogue scale (VAS) and Neck Disability Index (NDI) scores were compared.
RESULTS
RESULTS
The ACDR group had a significantly greater mean operative time (99.8 minutes vs 79.2 minutes, p<0.001), but comparable estimated blood loss and length of stay following surgical intervention (p=0.899). The overall complication rate was significantly greater in the ACDR group than the MI-PCF group (24.4% vs 6.2%; p=0.003) 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=0.002) 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<0.001).
CONCLUSION
CONCLUSIONS
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.
Identifiants
pubmed: 38185140
pii: S1529-9430(24)00003-2
doi: 10.1016/j.spinee.2023.12.010
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024. Published by Elsevier Inc.
Déclaration de conflit d'intérêts
Declaration of Competing Interest None.