gms | German Medical Science

Objective: Patients with cervical radiculopathy due to a soft-disc or mixed soft-/hard-disc prolapse have been operated utilizing an anterior or posterior approach. The decision on the approach was mainly by preference of the treating surgeon for lack of class I or class II evidence on this subject. This study shows the characteristics and outcome of a single center consecutive series of patients, which were operated via anterior cervical decompression and fusion (ACDF) or posterior foraminotomy (PF).

Method: We analyzed retrospectively 168 patients operated between 2008 and 2012. History, patient characteristics, treatment modality and early follow up at discharge were extracted from patient charts. Later follow-up were gathered during 2013 by a structured telephone interview or questionnaire. The exact Fisher-test or the non-parametric Mann-Whitney-U Test was performed for statistical analysis.

Results: Ninety-eight patients could be included with a mean follow-up of 43 (range 2-89) months. Seventy patients, mainly from foreign countries, were lost to follow-up. Thirty five patients (36%) were treated by ACDF and 63 patients (64%) by PF. Patient characteristics did not differ in terms of age, sex, BMI, pre-existing disease, radicular and nuchal pain, sensory deficits, neck disability index (NDI) values and soft-disc or mixed soft-/hard-disc prolapse. In ACDF patients C6 was mostly affected and in PF patients it was C7 level. PF patients presented more frequently with a motor deficit (p=0.017). Operating time and blood loss were significantly lower in PF patients (p=0.000 and p=0.003). Overall, patients experienced satisfactory results with good recovery from radicular pain in 82.9% of ACDF patients and 92.1% of PF patients (p=0.147). Initially, pain and sensory deficits resolved faster in ACDF patients (p=0.031 and p=0.018), but later VAS values showed a significantly larger decrease in PF patients (p=0.043). Paresis resolved partially or completely in 71.4% of ACDF patients and in 81% of PF patients (p=0.318). Decrease in NDI values from preop to late postop however was significantly larger in PF patients (p=0.004). Overall surgical complications did not differ. Odom's outcome criteria differed with 51.4% of ACDF patients with no or only minor residual symptoms versus 74.6% of PF patients (p=0.026).

Conclusions: Both treatment modalities achieved good results with PF patients performing better in terms of resolution of pain and paresis. That was partially foiled by a high reoperation rate for PF patients in the later course.