Comparative Analysis between Total Disc Replacement and Posterior Foraminotomy for Posterolateral Soft Disc Herniation with Unilateral Radiculopathy : Clinical and Biomechanical Results of a Minimum 5 Years Follow-up

Abstract

ObjectiveTo compare the clinical outcomes and biomechanical effects of total disc replacement (TDR) and posterior cervical foraminotomy (PCF) and to propose relative inclusion criteria.MethodsThirty-five patients who underwent surgery between 2006 and 2008 were included. All patients had single-level disease and only radiculopathy. The overall sagittal balance and angle and height of a functional segmental unit (FSU; upper and lower vertebral body of the operative lesion) were assessed by preoperative and follow-up radiographs. C2–7 range of motion (ROM), FSU, and the adjacent segment were also checked.ResultsThe clinical outcome of TDR (group A) was tended to be superior to that of PCF (group B) without statistical significance. In the group A, preoperative and postoperative upper adjacent segment level motion values were 8.6±2.3 and 8.4±2.0, and lower level motion values were 8.4±2.2 and 8.3±1.9. Preoperative and postoperative FSU heights were 37.0±2.1 and 37.1±1.8. In the group B, upper level adjacent segment motion values were 8.1±2.6 and 8.2±2.8, and lower level motion values were 6.5±3.3 and 6.3±3.1. FSU heights were 37.1±2.0 and 36.2±1.8. The postoperative FSU motion and height changes were significant (p<0.05). The patient’s satisfaction rates for surgery were 88.2% in group A and 88.8% in group B.ConclusionTDR and PCF have favorable outcomes in patients with unilateral soft disc herniation. However, patients have different biomechanical backgrounds, so the patient’s biomechanical characteristics and economic status should be understood and treated using the optimal procedure.

Minimally Invasive Posterior Cervical Foraminotomy Versus Anterior Cervical Fusion and Arthroplasty: Systematic Review and Meta-Analysis

“…Two studies were included that met inclusion criteria and directly compared outcomes between patients undergoing MIS-PCF and TDA ( Table 3 ). 57 , 58 Both studies were retrospective cohort series. Kim et al 58 2017 included 17 patients who underwent TDA with a Prestige LP cervical disc (Medtronic Sofamor Danek, Memphis, TN) and compared outcomes to 18 patients who underwent microscopic MIS-PCF with a tubular retractor system approach.…”

“…Operative time ranged from 90.3 to 106.7 minutes in the TDA group compared to 77.4 to 93.9 minutes in the MIS-PCF group. 57,58 The relationship was statistically significant with a shorter mean operative time in the MIS-PCF group in Kim et al 2017. 58 Mean postoperative length of stay ranged from 103.2 to 165.6 hours in the TDA group and 93.6 to 98.4 hours in the MIS-PCF group.…”

“…Ruetten relationship to be statistically significant with shorter postoperative stay after MIS-PCF. 54,58 There was significant variation in the postoperative length of stay after MIS-PCF as it ranged from 13.68 to 98.4 hours across all studies. There is a current trend to perform all three procedures in an outpatient setting in order to decrease costs associated with admission and inpatient care.…”

“…Overall six studies were included in quantitative synthesis including four studies that directly compare MIS-PCF to ACDF, one study that directly compares MIS-PCF to TDA, and one study that compares MIS-PCF to both ACDF and TDA. [53][54][55][56][57][58] A flow chart of study inclusion and exclusion is shown in Figure 1.…”

Feasibility of Posterior Cervical Foraminotomy for Adjacent Segmental Disease after Anterior Cervical Fusion

“…Secondly, the previous surgery in 32 cases (86.4%) was ACDF and 12 (37.5%) of these were performed using a standalone technique. ACDF is a widely accepted standard surgery for cervical spondylosis; however, recent studies suggest that the ROM at adjacent levels is significantly higher than that obtained with CDR or PCF by fixing the ROM for the index level 11,17) . Han et al 8) reported that the stand-alone ACDF group showed more frequent segmental subsidence and cervical kyphosis than the conventional ACDF group.…”