Anterior or posterior approach in the surgical treatment of cervical radiculopathy; neurosurgeons’ preference in the Netherlands

Broekema, Anne E.H.; Groen, Rob J. M.; Tegzess, Erzsi; Reneman, Michiel F.; Soer, Remko; Kuijlen, Jos M. A.

doi:10.1016/j.inat.2020.100930

Cited by 4 publications

(6 citation statements)

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“…Two widely used interventions are posterior cervical foraminotomy (posterior surgery) or anterior cervical discectomy with fusion (ACDF; anterior surgery). Although posterior surgery involves fewer vital structures than anterior surgery (eg, esophagus, carotid artery, and recurrent laryngeal nerve) and does not require costly implants, surgeons still tend to prefer the latter . Both techniques have been shown to yield similar clinical outcomes; however, these findings are based on retrospective cohort studies and 1 low-quality randomized clinical trial with few patients .…”

Section: Introductionmentioning

confidence: 99%

“…Although posterior surgery involves fewer vital structures than anterior surgery (eg, esophagus, carotid artery, and recurrent laryngeal nerve) and does not require costly implants, surgeons still tend to prefer the latter. 3,4 Both techniques have been shown to yield similar clinical outcomes; however, these findings are based on retrospective cohort studies and 1 low-quality randomized clinical trial with few patients. [5][6][7][8] A randomized clinical trial with a predefined sample size directly comparing the 2 techniques is needed to elucidate the existing controversy in cervical spine surgery.…”

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confidence: 99%

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Noninferiority of Posterior Cervical Foraminotomy vs Anterior Cervical Discectomy With Fusion for Procedural Success and Reduction in Arm Pain Among Patients With Cervical Radiculopathy at 1 Year

et al. 2023

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ImportanceThe choice between posterior cervical foraminotomy (posterior surgery) and anterior cervical discectomy with fusion (anterior surgery) for cervical foraminal radiculopathy remains controversial.ObjectiveTo investigate the noninferiority of posterior vs anterior surgery in patients with cervical foraminal radiculopathy with regard to clinical outcomes after 1 year.Design, Setting, and ParticipantsThis multicenter investigator-blinded noninferiority randomized clinical trial was conducted from January 2016 to May 2020 with a total follow-up of 2 years. Patients were included from 9 hospitals in the Netherlands. Of 389 adult patients with 1-sided single-level cervical foraminal radiculopathy screened for eligibility, 124 declined to participate or did not meet eligibility criteria. Patients with pure axial neck pain without radicular pain were not eligible. Of 265 patients randomized (132 to posterior and 133 to anterior), 15 were lost to follow-up and 228 were included in the 1-year analysis (110 in posterior and 118 in anterior).InterventionsPatients were randomly assigned 1:1 to posterior foraminotomy or anterior cervical discectomy with fusion.Main Outcomes and MeasuresPrimary outcomes were proportion of success using Odom criteria and decrease in arm pain using a visual analogue scale from 0 to 100 with a noninferiority margin of 10% (assuming advantages with posterior surgery over anterior surgery that would justify a tolerable loss of efficacy of 10%). Secondary outcomes were neck pain, disability, quality of life, work status, treatment satisfaction, reoperations, and complications. Analyses were performed with 2-proportion z tests at 1-sided .05 significance levels with Bonferroni corrections.ResultsAmong 265 included patients, the mean (SD) age was 51.2 (8.3) years; 133 patients (50%) were female and 132 (50%) were male. Patients were randomly assigned to posterior (132) or anterior (133) surgery. The proportion of success was 0.88 (86 of 98) in the posterior surgery group and 0.76 (81 of 106) in the anterior surgery group (difference, −0.11 percentage points; 1-sided 95% CI, −0.01) and the between-group difference in arm pain was −2.8 (1-sided 95% CI, −9.4) at 1-year follow-up, indicating noninferiority of posterior surgery. Decrease in arm pain had a between-group difference of 3.4 (1-sided 95% CI, 11.8), crossing the noninferiority margin with 1.8 points. All secondary outcomes had 2-sided 95% CIs clustered around 0 with small between-group differences.Conclusions and RelevanceIn this randomized clinical trial, posterior surgery was noninferior to anterior surgery for patients with cervical radiculopathy regarding success rate and arm pain at 1 year. Decrease in arm pain and secondary outcomes had small between-group differences. These results may be used to enhance shared decision-making.Trial RegistrationNetherlands Trial Register Identifier: NTR5536

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Section: Introductionmentioning

confidence: 99%

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Noninferiority of Posterior Cervical Foraminotomy vs Anterior Cervical Discectomy With Fusion for Procedural Success and Reduction in Arm Pain Among Patients With Cervical Radiculopathy at 1 Year

et al. 2023

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“…Posterior cervical foraminotomy (posterior surgery) and anterior cervical discectomy with fusion (anterior surgery) are common surgical treatments for cervical radiculopathy. Currently, the decision for either technique is typically based on the surgeon’s preference and experience, in the absence of high-quality, evidence-based recommendations 1-3 .…”

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“…However, a preference among surgeons for anterior surgery has been observed 1,9 . One of the reasons for this could be the belief that patients experience more short-term neck pain after posterior surgery 1,10 , although literature with regard to this matter has been limited. One retrospective study compared neck pain in the first 5 to 7 postoperative days, reporting a significant difference in neck pain favoring anterior surgery over posterior surgery 10 .…”

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Short-Term Neck Pain After Posterior Foraminotomy Compared with Anterior Discectomy with Fusion for Cervical Foraminal Radiculopathy

Souza¹,

Broekema²,

Soer³

et al. 2023

Journal of Bone and Joint Surgery

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Background:Short-term neck pain after posterior cervical foraminotomy (posterior surgery) compared with anterior cervical discectomy with fusion (anterior surgery) treating cervical radiculopathy has only been assessed once, retrospectively, to our knowledge. The aim of this study was to prospectively evaluate the course of neck pain for 6 weeks after both treatments.Methods:This is a secondary analysis of the multicenter Foraminotomy ACDF Cost-Effectiveness Trial (FACET), conducted from January 2016 to May 2020. Of 389 patients who had single-level, 1-sided cervical radiculopathy and were screened for eligibility, 265 were randomly assigned to undergo posterior surgery (n = 132) or anterior surgery (n = 133). The primary outcome of the present analysis was neck pain, assessed weekly for 6 weeks using the visual analog scale (VAS), on a scale of 0 to 100. The secondary outcomes were arm pain, neck disability, work ability, quality of life, treatment satisfaction, motor and sensory changes, and hospital length of stay. Data were analyzed with mixed model analysis in intention-to-treat samples using 2-sided 95% confidence intervals (CIs).Results:In the first postoperative week, the mean VAS for neck pain was 56.2 mm (95% CI, 51.7 to 60.8 mm) after posterior surgery and 46.7 mm (95% CI, 42.2 to 51.2 mm) after anterior surgery. The mean between-group difference was 9.5 mm (95% CI, 3.3 to 15.7 mm), which gradually decreased to 2.3 mm (95% CI, −3.6 to 8.1 mm) at postoperative week 6. As of postoperative week 5, there was no significant difference between groups. Responder analyses confirmed this result. Secondary outcomes showed small differences between groups.Conclusions:Insight into the course of neck pain during the first 6 weeks after posterior compared with anterior surgery is provided. Despite initially more neck pain after posterior surgery, patients swiftly improved and, as of postoperative week 5, results similar to those after anterior surgery were observed. Our findings should enable improved patient counseling and enhanced shared decision-making between physicians and patients with cervical radiculopathy, where more neck pain in the first postoperative weeks should be balanced against the benefits of posterior surgery.Level of Evidence:Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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Porous interbody fusion cage design via topology optimization and biomechanical performance analysis

Zhang

Tang

et al. 2022

Computer Methods in Biomechanics and Biomedical Engineering

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Anterior or posterior approach in the surgical treatment of cervical radiculopathy; neurosurgeons’ preference in the Netherlands

Cited by 4 publications

References 25 publications

Noninferiority of Posterior Cervical Foraminotomy vs Anterior Cervical Discectomy With Fusion for Procedural Success and Reduction in Arm Pain Among Patients With Cervical Radiculopathy at 1 Year

Noninferiority of Posterior Cervical Foraminotomy vs Anterior Cervical Discectomy With Fusion for Procedural Success and Reduction in Arm Pain Among Patients With Cervical Radiculopathy at 1 Year

Short-Term Neck Pain After Posterior Foraminotomy Compared with Anterior Discectomy with Fusion for Cervical Foraminal Radiculopathy

Porous interbody fusion cage design via topology optimization and biomechanical performance analysis

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