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Comparison of Anterior Cervical Foraminotomy and Posterior Cervical Foraminotomy for Treating Single Level Unilateral Cervical Radiculopathy

Kim, Shin-Jae MD; Seo, Jin-Suk MD; Lee, Sang-Ho MD, PhD; Bae, Junseok MD

doi: 10.1097/BRS.0000000000003081

Study Design. Retrospective study.

Objective. To compare clinical and radiological outcomes after two surgical procedures.

Summary of Background Data. Anterior cervical discectomy and fusion is the gold standard treatment for cervical radiculopathy. Cervical foraminotomy is an alternative decompressive treatment option to preserve segmental motion and avoid fusion-related complications. Anterior cervical foraminotomy (ACF) and posterior cervical foraminotmy (PCF) has been introduced to achieve foraminal decompression. The objective of this study was to compare long-term clinical and radiological outcomes after two surgical procedures for the treatment of single-level cervical radiculopathy.

Methods. A retrospective review of patients undergoing ACF or PCF for the treatment of single-level unilateral cervical radiculopathy from 2010 to 2012 was performed. Demographic, perioperative, and clinical outcomes of 40 patients for each group were collected from the electronic medical records. Clinical outcomes were assessed by visual analog scores, while disc height (DH), cervical lordosis (CL), and C2–7 sagittal vertical axis (C2–7 SVA) data were obtained from pre- and postoperative radiography data.

Results. Both groups showed similar clinical improvements after surgery. Radiographically, the ACF groups showed profound decrease in DH only at the first month after surgery, and there was no significant change in DH after 1 year. The PCF group showed no significant changes in DH at follow-up. With respect to CL, ACF showed a significant decrease. There was no statistically significant change in C2–7 SVA before or after surgery in both groups.

Conclusion. Both ACF and PCF showed significant clinical improvement of radiculopathy. In the ACF group, the DH decreased, and CL decreased during the early postoperative period. Radiological parameters were preserved in the PCF group after surgery. However, this group showed greater intraoperative bleeding and revision rates. Care should be taken to manage complications according to the specific surgical treatment.

Level of Evidence: 3

The purpose of this clinical study was to compare the clinical and radiological outcomes of anterior cervical foraminotomy (ACF) and posterior cervical foraminotomy (PCF). The results showed that the ACF group had lower disc height and more kyphotic changes after surgery than the PCF group, suggesting that ACF may induce more subsidence and kyphosis than PCF.

Department of Neurosurgery, Chungdam Wooridul Spine Hospital, Seoul, Republic of Korea.

Address correspondence and reprint requests to Junseok Bae, MD, Department of Neurosurgery, Chungdam Wooridul Spine Hospital, 445, Hakdong-ro, Gangnam-gu, 06068 Seoul, Republic of Korea; E-mail:

Received 17 October, 2018

Revised 21 December, 2018

Accepted 28 March, 2019

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.