Artikel
Posterior foraminotomy versus anterior decompression and fusion in patients with cervical degenerative disc disease with radiculopathy ‒ 5-year outcome from the National Swedish Spine Register
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Autoren
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Anna MacDowall
- Uppsala University, Department of Surgical Sciences, Uppsala, Sweden
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Robert F. Heary
- Uppsala University, Department of Surgical Sciences, Uppsala, Sweden
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Marek Holy
- Uppsala University, Department of Surgical Sciences, Uppsala, Sweden
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Claes Olerud
- Uppsala University, Department of Surgical Sciences, Uppsala, Sweden
| Veröffentlicht: | 8. Mai 2019 |
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Gliederung
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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 setting.
Methods: Observational study of a cohort with prospectively collected data.
All patients in the national Swespine register 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 outcomes measures (PROMs). Secondary surgeries were also accounted for.
Results: A total of 4,368 patients (2,136/2,232 women/men) met the inclusion criteria. Posterior foraminotomy was performed in 647 patients and 3,721 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, there was not a significant difference (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 numeric rating scale (NRS) for neck and arm. More reoperations were seen in the foraminotomy group, 9% versus 4% in the fusion group (P
Conclusion: In patients with cervical degenerative disc disease and radiculopathy, both groups demonstrated clinical improvements, at 5-year follow-up, which were comparable and did not achieve a clinically important difference from one another. This study design obtains population-based results, which are generalizable.
Figure 1 [Fig. 1]
