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Evaluation of Current Trends in Treatment of Single-level Cervical Radiculopathy

Mok, Jung K. BS*; Sheha, Evan D. MD; Samuel, Andre M. MD; McAnany, Steven J. MD*,†; Vaishnav, Avani S. MBBS; Albert, Todd J. MD*,†; Gang, Catherine Himo MPH; Qureshi, Sheeraz MD, MBA*,†

doi: 10.1097/BSD.0000000000000796

Study design: This was a retrospective cohort study.

Objectives: The main objectives of this study were to identify epidemiological trends, differences, and complications in patients undergoing surgical treatment for single-level cervical radiculopathy (SLCR).

Summary of Background Data: SLCR that fails nonoperative management is effectively treated with either anterior cervical discectomy and fusion (ACDF), cervical disc replacement (CDR), or posterior cervical foraminotomy (PCF). Although studies have shown that all 3 options are clinically effective, trends in usage, differences in patient population, and differences in complications remain unknown.

Materials and Methods: Patients who underwent either ACDF, CDR, or PCF in the treatment of SLCR from 2010 to 2016 were retrospectively reviewed using the National Surgical Quality Improvement Program (NSQIP) database. Demographic data consisted of sex, age, ASA class, body mass index, and inpatient/outpatient status. Complications included surgical site infection, pneumonia, reintubation, pulmonary embolism, deep vein thrombosis, readmissions, reoperations, operating time, and hospital length of stay. Utilization trends by year among the 3 procedures were also analyzed.

Results: A total of 1102 patients with SLCR treated with single-level ACDF, CDR, or PCF were identified in NSQIP from 2010 to 2016. There was a relative increase in the number of CDR procedures (7.7%–16.1%) and a corresponding decrease in PCF procedures (20.3%–10.6%) without a significant effect on ACDF procedures (72.0%–73.3%). Patients who underwent CDR were younger and in a lower ASA class than those undergoing ACDF or PCF. Patients undergoing PCF were more likely to be treated as an outpatient. PCF procedures also had the shortest operating time and hospital length of stay. There were no significant differences in complications among the 3 procedures. Moreover, there were no significant trends in demographics or outcome measures.

Conclusions: ACDF remains the most common surgical treatment for patients with SLCR, and its utilization has remained consistent. Meanwhile, the increased utilization of CDR for the treatment of SLCR has resulted in a corresponding decrease in the utilization of PCF.

*Weill Cornell Medicine

Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY

S.Q. is currently receiving Grant/Research Support from the Cervical Spine Research Society; Consulting Fees from Zimmer-Biomet, Stryker Spine, and Globus Medical Inc.; Shareholder Interest in Avaz Surgical; and Royalties from RTI, Zimmer-Biomet, and Stryker Spine. T.J.A. is currently receiving Grant/Research Support from PCORI, ISSG, and NIH; Royalties from Zimmer-Biomet, DePuy Synthes, Nuvasive, JP Medical Publishers, Saunders/Mosby-Elseveir, and Thieme; Consulting Fees from Facet Link, DePuy, Biomet, Nuvasive, and Gentis (Medical Advisory Board); Stock/Investment Interests from Vital 5, Bonovo Orthopedics Inc., Biomerix, InVivo Therapeutics, Spinicity, Crosstrees Medical, Paradigm Spine LLC, Invuity, Gentis, ASIP, PMIG, and Pioneer. The remaining authors declare no conflict of interest.

Reprints: Sheeraz Qureshi, MD, MBA, Department of Orthopedic Surgery, Hospital for Special Surgery, 535 E 71st St., New York, NY 10021 (e-mail:

Received May 4, 2018

Accepted January 3, 2019

© 2019 by Lippincott Williams & Wilkins, Inc.