Posterior surgery noninferior to anterior for treating cervical radiculopathy

Posterior cervical foraminotomy was noninferior to anterior cervical discectomy with fusion in success rate and arm pain at 1 year in patients with cervical radiculopathy, researchers reported in JAMA Neurology.

Anne E. H. Broekema, MD, of the department of neurosurgery at the University of Groningen in the Netherlands, and colleagues conducted a multicenter, randomized clinical trial to assess 1-year clinical outcomes after surgery in patients with cervical foraminal radiculopathy.

They screened 389 adults with one-sided, single-level cervical foraminal radiculopathy from nine hospitals in the Netherlands. Primary outcomes of interest included proportion of a successful score using the Odom criteria 4-point rating scale, as well as a decrease in self-reported arm pain using a visual analogue scale from 0 to 100 with a noninferiority margin of 10%. Of 265 patients included (mean age, 51.2 years; 50% women), 132 underwent posterior surgery and 133 underwent anterior surgery.

According to results, the proportion of patients with a successful outcome at 1 year was 0.88 in the posterior group and 0.76 in the anterior group (difference = –0.11 percentage points). In the posterior group, mean arm pain decreased from 62.3 at baseline to 18.6 at 1 year, while the anterior group reported a reduction from 60.3 to 15.8 — a between-group difference of –2.8, which indicated noninferiority.

In addition, the between-group difference for the change in arm pain score was 3.4, which crossed the noninferiority margin of 10% with 1.8 points.

“In this randomized clinical trial of patients with cervical radiculopathy due to foraminal nerve root compression, the 1-year clinical effectiveness results demonstrate noninferiority of success rate and arm pain in posterior vs. anterior surgery at 1-year follow-up,” Broekema and colleagues wrote.