Posterior cervical foraminotomy may be noninferior vs. anterior surgery for radiculopathy
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Key takeaways:
- Posterior cervical foraminotomy was deemed noninferior to anterior cervical discectomy and fusion at 2-year follow-up.
- Both procedures may be discussed when counseling patients with cervical radiculopathy.
With comparable outcomes at 2 years, posterior cervical foraminotomy may be an effective alternative to anterior cervical discectomy and fusion for patients with cervical radiculopathy, according to published results.
Nádia F. Simões de Souza, MD, from the University Medical Center Groningen in the Netherlands, and colleagues from the Foraminotomy Anterior Cervical Discectomy and Fusion Cost-Effectiveness Trial, known as FACET, randomly assigned patients with single-level cervical radiculopathy to undergo either posterior cervical foraminotomy (n = 119) or anterior cervical discectomy and fusion (n = 124) between January 2016 and May 2020. The noninferiority trial included patients at nine Dutch hospitals.
“Posterior surgery has advantages over anterior surgery, such as avoidance of vital structures, no need for an intervertebral spacer, a better economic profile and maintenance of range of motion,” Simões de Souza and colleagues wrote in the study.
At 2 years, Simões de Souza and colleagues found the proportion of patients with a successful outcome was 0.81 in the posterior group and 0.74 in the anterior group. In addition, they found the between-group difference in mean arm pain was –2.7 at 2 years. They noted the between-group differences at each follow-up time point demonstrated noninferiority of posterior surgery.
Simões de Souza and colleagues also found 8% of patients who underwent posterior surgery had an adverse event, including nine reoperations, while 9% of patients who underwent anterior surgery had an adverse event, including seven reoperations.
“Given the current existing preference for anterior surgery, widespread awareness of these results is important, as both procedures should be discussed in patient counseling,” Simões de Souza and colleagues concluded.
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