Microscopic Anterior Cervical Discectomy and Fusion Versus Posterior Percutaneous Endoscopic Cervical Keyhole Foraminotomy for Single-level Unilateral Cervical Radiculopathy

Abstract

Study Design: A systematic review and meta-analysis. Objective: The objective of this study was to compare the safety of microscopic anterior cervical discectomy and fusion (MI-ACDF) and posterior percutaneous endoscopic keyhole foraminotomy (PPEKF) in patients diagnosed with single-level unilateral cervical radiculopathy. Summary of Background Data: After conservative treatment, the symptoms will be relieved in about 90% of cervical radiculopathy patients. For the other one tenth of patients, surgical treatment is needed. The overall complication rate of MI-ACDF and PPEKF ranges from 0% to 25%, and the reoperation rate ranges from 0% to 20%. Materials and Methods: Electronic retrieval of studies from PubMed, Embase, and Cochrane Library was performed to identify comparative or single-arm studies on MI-ACDF and PPEKF. A total of 24 studies were included in our meta-analysis by screening according to the inclusion and exclusion criteria. After data extraction and quality assessment of the included studies, a meta-analysis was performed by using the R software. The pooled incidences of efficient rate, total complication rate, and reoperation rate were calculated. Results: A total of 24 studies with 1345 patients (MI-ACDF: 644, PPEKF: 701) were identified. There was no significantly statistical difference in pooled patient effective rate (MI-ACDF: 94.3% vs. PPEKF: 93.3%, P=0.625), total complication rate (MI-ACDF: 7.1% vs. PPEKF: 4.7%, P=0.198), and reoperation rate (MI-ACDF: 1.8% vs. PPEKF: 1.1%, P=0.312). However, the common complications of the 2 procedures were different. The most common complications of MI-ACDF were dysphagia and vertebral body sinking, whereas the most common complication of PPEKF was nerve root palsy. Conclusions: Both MI-ACDF and PPEKF can provide a relatively safe and reliable treatment for single-level unilateral cervical radiculopathy. The 2 techniques are not significantly different in terms of effective rate, total complication rate, and reoperation rate.

Single-level Anterior Cervical discEctomy and Fusion has Lower Five-year Revisions than Posterior Cervical Foraminotomy in a Large National Cohort

“…At five years, PCF cases had a significantly higher rate of subsequent cervical spine surgery relative to ACDF cases (19.0% vs. 14.8%). Prior literature had been mixed on this finding in the past, with some maintaining no difference between ACDF and PCF 10–12,25 while others found higher rates for PCF 13,14 . It is likely that greater statistical power afforded by greater patient numbers in the current study was needed to identify this difference.…”

“…12 A meta-analysis by Guo et al, found no significant differences in pooled total complication rates and revision rates between single-level ACDF and PCF groups. 13 Another meta-analysis from Fang et al found perioperative outcomes to be similar between the groups, but unlike the previous review, significantly higher revision rates for those undergoing PCF. 14 Given the mixed literature regarding outcomes of ACDF versus PCF, establishing the relative risks and benefits of both approaches is critical for guiding proper surgical decision-making.…”

“…Prior literature had been mixed on this finding in the past, with some maintaining no difference between ACDF and PCF [10][11][12]25 while others found higher rates for PCF. 13,14 It is likely that greater statistical power afforded by greater patient numbers in the current study was needed to identify this difference. In addition, the Kaplan-Meier curves in this study increasingly separated over time, indicating the need for a sufficient follow-up to determine differences in these reoperation rates.…”

“…A national database study from the Swedish Spine Register found PCF to have a higher revision rate 12 . A meta-analysis by Guo et al , found no significant differences in pooled total complication rates and revision rates between single-level ACDF and PCF groups 13 . Another meta-analysis from Fang et al found perioperative outcomes to be similar between the groups, but unlike the previous review, significantly higher revision rates for those undergoing PCF 14 …”

Complications and Management of Endoscopic Spinal Surgery

“…Regardless of the cervical anterior or posterior approach method, several literatures on the complications of full endoscopic cervical surgery have already been reported. According to the analysis of complications of endoscopic spinal surgery, Guo et al 41 reported total complication rate of 4.7% and a reoperation rate of 1.1% in cervical endoscopic surgery. In anterior full en-doscopic cervical surgery, recurrent laryngeal nerve injury and swallowing dysfunction are unique complications of this method.…”