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Research ArticleCervical Spine

Comparison of Single-Level Posterior Cervical Foraminotomy to Anterior Cervical Discectomy and Fusion for Radiculopathy

Gabrielle Santangelo, Connor Wathen, Dominick Macaluso, Mert Marcel Dagli, Zarina S. Ali, Neil R. Malhotra, David S. Casper, Michael Spadola, Yohannes Ghenbot, Khush Thakkar, Gabriella Maze, William C. Welch and Ali K. Ozturk
International Journal of Spine Surgery June 2023, 17 (3) 418-425; DOI: https://doi.org/10.14444/8447
Gabrielle Santangelo
1 Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
2 Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA
MD
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  • For correspondence: santanga@pennmedicine.upenn.edu
Connor Wathen
1 Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
MD
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Dominick Macaluso
1 Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
PHD
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Mert Marcel Dagli
1 Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
BS
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Zarina S. Ali
1 Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
MD, MS
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Neil R. Malhotra
1 Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
MD
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David S. Casper
1 Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
MD
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Michael Spadola
1 Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
MD
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Yohannes Ghenbot
1 Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
MD
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Khush Thakkar
1 Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Gabriella Maze
1 Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
BS
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William C. Welch
1 Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
MD
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Ali K. Ozturk
1 Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
MD
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    Figure 1

    Comorbidities by surgery type. There was no significant difference between groups in preoperative comorbidities. The most commonly observed comorbidities were chronic obstructive pulmonary disease and diabetes mellitus in both groups. ACDF, anterior cervical discectomy and fusion.

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    Figure 2

    Cervical levels treated by surgery type. There was a significant difference between groups in the levels most commonly treated. Within the anterior cervical discectomy and fusion (ACDF) group, patients most often underwent surgery at the C5-C6 level followed by C6-C7 vs the posterior cervical foraminotomy group that more frequently underwent decompression at C6-C7 followed by C5-C6.

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    Figure 3

    Reasons for reoperation of total cohort. Reoperation was most commonly performed for recurrent symptoms in both groups followed by instrumentation-related complications such as pseudarthrosis and adjacent segment disease.

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    Figure 4

    Reasons for reoperation by surgery type. Reoperation for recurrent symptoms was not statistically different between groups. There was significantly more reoperation for adjacent segment disease in the anterior cervical discectomy and fusion (ACDF) group. There were more reoperations for wound infections in the posterior cervical foraminotomy group.

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    Table 1

    Perioperative patient characteristics.

    VariableACDFPCFSignificance for Equality of Means (P Value)
    N Mean (SD)SEM N Mean (SD)SEM
    Age at encounter23651.03 (11.14)0.7313851.3 (10.67)0.910.82
    Body mass index23028.57 (6.16)0.4013728.14 (5.15)0.440.50
    Charlson Comorbidity Index2361.89 (2.01)0.131381.68 (1.50)0.130.25
    American Society of Anesthesiologists2362.22 (0.56)0.041382.11 (0.46)0.04 0.031
    Procedure time in minutes236124.78 (69.51)4.53138124.79 (67.44)5.740.998
    Days to reoperation26247.88 (200.59)39.348319.25 (252.53)89.280.413
    • Abbreviations: ACDF, anterior cervical discectomy and fusion; PCF, posterior cervical foraminotomy; SEM, standard error of the mean.

    • Bolded values indicate significance at P < 0.05

    • View popup
    Table 2

    Linear regression of length of stay predictors.

    Lenght of Stay PredictorUnstandardized CoefficientsStandardized Coefficients t Value P Value
    B Standard Errorβ
    Constant1.440.572.540.01
    ACDF = 0, PCF = 1−0.170.15−0.06−1.120.27
    Age−0.020.01−0.13−1.920.06
    Body mass index0.010.010.061.160.25
    Charlson Comorbidity Index0.160.050.223.32 <0.01
    Male = 0, Female = 10.450.140.173.19 <0.01
    Level0.030.080.020.330.74
    • Abbreviations: ACDF, anterior cervical discectomy and fusion; PCF, posterior cervical foraminotomy.

    • Bolded values indicate significance at P < 0.05

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International Journal of Spine Surgery
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1 Jun 2023
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Comparison of Single-Level Posterior Cervical Foraminotomy to Anterior Cervical Discectomy and Fusion for Radiculopathy
Gabrielle Santangelo, Connor Wathen, Dominick Macaluso, Mert Marcel Dagli, Zarina S. Ali, Neil R. Malhotra, David S. Casper, Michael Spadola, Yohannes Ghenbot, Khush Thakkar, Gabriella Maze, William C. Welch, Ali K. Ozturk
International Journal of Spine Surgery Jun 2023, 17 (3) 418-425; DOI: 10.14444/8447

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Comparison of Single-Level Posterior Cervical Foraminotomy to Anterior Cervical Discectomy and Fusion for Radiculopathy
Gabrielle Santangelo, Connor Wathen, Dominick Macaluso, Mert Marcel Dagli, Zarina S. Ali, Neil R. Malhotra, David S. Casper, Michael Spadola, Yohannes Ghenbot, Khush Thakkar, Gabriella Maze, William C. Welch, Ali K. Ozturk
International Journal of Spine Surgery Jun 2023, 17 (3) 418-425; DOI: 10.14444/8447
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Keywords

  • posterior cervical foraminotomy
  • anterior cervical discectomy and fusion
  • radiculopathy
  • readmission
  • reoperation

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