Posterior Surgery Is Noninferior to Anterior Surgery for Cervical Radiculopathy
A study from the Netherlands has demonstrated that patients experience comparable results when they undergo either posterior foraminotomy or the more commonly performed anterior cervical discectomy with fusion (ACDF) to treat cervical radiculopathy.
The researchers, from University Medical Center Groningen in the Netherlands, said their findings “provide Level-I evidence that posterior surgery is noninferior to anterior surgery with regard to the clinical outcome, with follow-up of two years.”
This study, published online ahead of print by The Journal of Bone & Joint Surgery, builds on the previous results from the randomized Foraminotomy ACDF Cost-Effectiveness Trial (FACET), which at 1-year follow-up, also reported that posterior surgery was noninferior to anterior surgery. The new report extends the FACET findings to a second year of follow-up.
Study Methods and Findings
The researchers analyzed primary outcome data for 236 patients with single-level cervical radiculopathy who were assigned to posterior foraminotomy or ACDF at 9 Dutch hospitals. The main outcomes of interest were the surgical success ratio, based on Odom criteria (symptom improvement and ability to perform daily activities), and decrease in arm pain.
On extended follow-up, the outcomes of the 2 approaches remained similar. Two-year surgical success rate was 81% in patients assigned to posterior surgery and 74% for anterior surgery. The difference was within the specified noninferiority margin of 10 percentage points.
The 2 groups also had similar reductions in arm pain, with a difference of 3 percentage points.
The procedures yielded similar improvement in secondary outcomes, including neck pain, disability, work ability, and quality of life, as well as treatment satisfaction. For most outcomes, change scores reached prespecified thresholds for clinically relevant improvement.
In addition, the 2 groups had similar rates of serious surgery-related adverse events (8% in the posterior group and 9% in the anterior group), including revision surgery.
Implications for Patients
The “demonstrated noninferiority” of posterior compared with anterior surgery is consistent with the findings of previous retrospective studies. Rates of recurrent symptoms and revision surgery were slightly higher after posterior surgery, although the trial was not powered to draw firm conclusions based on these outcomes. Posterior surgery also has some potential advantages: It involves fewer vital structures, avoids the need for implants, and has lower costs.
The researchers believe their findings have implications for discussions of treatment options for cervical radiculopathy.
“As both procedures have similar clinical outcome profiles, the emphasis in patient counseling should be on the types of complications for each procedure, patient-specific factors, and potential sustainability,” the researchers concluded.
“Both physician and patient should individually weigh the advantages and disadvantages of both procedures.”
Source
Simões de Souza NF, Broekema AEH, Reneman MF, et al. Posterior cervical foraminotomy compared with anterior cervical discectomy with fusion for cervical radiculopathy: two-year results of the FACET randomized noninferiority study. J Bone Joint Surg Am. 2024 Jul 24. doi: 10.2106/JBJS.23.00775. Online ahead of print.