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Low rate found for initial posterior cervical foraminotomy revised with ACDF at index level

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NEW ORLEANS — Researchers discovered the conversion rate of an initial posterior cervical foraminotomy to anterior cervical discectomy and fusion at the index level is 5%, which is comparable to the reoperation rate of anterior cervical discectomy and fusion.

"We found that [posterior cervical foraminotomy] PCF is associated with a very low reoperation rate and had similar to historical reoperation rates of [anterior cervical discectomy and fusion] ACDF at the index level. In conclusion, spine surgeons can consider PCF as an equal alternative in terms of revision surgery," Thomas E. Mroz, MD, said at the North American Spine Society Annual Meeting.

To determine the rates and potential risk factors of ACDF after PCF at the index level, the investigators performed a retrospective chart review and telephone survey of 178 adult patients who underwent PCF as an index procedure at the Cleveland Clinic between 2004 and 2011. Patients who had a previous cervical surgery were excluded from the study.

The investigators found nine patients were revised with an ACDF at the index level. The average follow-up was 31 months for the 169 patients who did not have a revision and 38 months for the revision group.

There were no significant differences between the revision and nonrevision groups for operative indications or postoperative complications.

"In terms of looking at all of the other comorbidities, we only found that patients who were younger, patients who were thinner and [patients who] had a lower body mass index were at risk for having an ACDF as a revision procedure following an index PCF," Mroz said.

He added, "Interestingly, while not statistically significant, patients who underwent the revision surgery who failed the PCF, they on average had a longer duration of preoperative symptoms for the index procedure at 15 months compared to 8.6 months [for the nonrevision group]."

Reference:

Wang TY. Paper #14. Presented at: North American Spine Society Annual Meeting; Oct. 9-12, 2013; New Orleans.

Disclosure: Mroz has no relevant financial disclosures.