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Comparing Outcomes Between Anterior Cervical Disc Replacement (ACDR) And Minimally Invasive Posterior Cervical Foraminotomy (MI-PCF) In The Treatment Of Cervical Radiculopathy – Cervical Disc Replacement

The article compares the clinical and functional outcomes of anterior cervical disc replacement (ACDR) and minimally invasive posterior cervical foraminotomy (MI-PCF) as alternatives to anterior cervical discectomy and fusion (ACDF) for treating cervical radiculopathy. A retrospective cohort review was conducted on 152 patients who underwent either ACDR or MI-PCF. The study found that the ACDR group had longer operative times and a higher overall complication rate, largely due to approach-related dysphagia. However, ACDR had lower revision rates and greater improvements in Neck Disability Index (NDI) scores compared to MI-PCF. The study concludes that ACDR provides advantages in terms of long-term revision rates, despite the increased risk of transient postoperative dysphagia

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

Our results suggest that ACDR offer clinically relevant advantages over MI-PCF in terms of long-term revision rates despite an increased approach-related risk of transient postoperative dysphagia. Additionally, patients in the ACDR cohort achieved greater mean improvements in NDI scores but these results may have limited clinical significance due to inability to reach minimally clinically important difference (MCID) thresholds.

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Abstract Background context: Anterior cervical disc replacement (ACDR) and minimally invasive posterior cervical foraminotomy (MI-PCF) have emerged as two increasingly popular alternatives to anterior cervical discectomy and fusion (ACDF) for the management of cervical radiculopathy. Both techniques provide advantages of segmental motion preservation and lower rates of adjacent segment degeneration (ASD) compared to ACDF. Purpose:,

Abstract

Background context: Anterior cervical disc replacement (ACDR) and minimally invasive posterior cervical foraminotomy (MI-PCF) have emerged as two increasingly popular alternatives to anterior cervical discectomy and fusion (ACDF) for the management of cervical radiculopathy. Both techniques provide advantages of segmental motion preservation and lower rates of adjacent segment degeneration (ASD) compared to ACDF.

Purpose: The purpose of this study was to analyze the clinical and functional outcomes of patients undergoing ACDR or MI-PCF for the treatment of unilateral cervical radiculopathy.

Study design/setting: Retrospective Cohort Review PATIENT SAMPLE: 152 patients were included (86 ACDR and 66 MI-PCF).

Outcome measures: 1) Patient demographics; 2) Perioperative data; 3) Rates of complications and revisions; 5) Visual analogue scale (VAS) and Neck Disability Index (NDI) scores METHODS: A retrospective cohort review was performed to identify all patients at a single institution between 2012-2020 who underwent 1- or 2- level ACDR or MI-PCF from C3-C7 with a minimum follow-up of 24 months. Patient demographics, perioperative data, postoperative complications, and revisions were analyzed. Patient reported outcome measures including Visual analogue scale (VAS) and Neck Disability Index (NDI) scores were compared.

Results: The ACDR group had a significantly greater mean operative time (99.8 minutes vs 79.2 minutes, p<0.001), but comparable estimated blood loss and length of stay following surgical intervention (p=0.899). The overall complication rate was significantly greater in the ACDR group than the MI-PCF group (24.4% vs 6.2%; p=0.003) but was largely driven by approach-related dysphagia in 20.9% of ACDR patients. The MI-PCF group had significantly greater revision rates (13.6% vs 1.2%; p=0.002) with an average time to revision of 20.7 months in the MI-PCF group compared to 40.3 months in the ACDR group. The ACDR cohort had significantly greater improvements in NDI scores at the final follow-up (25.0 vs 21.3, p<0.001).

Our results suggest that ACDR offer clinically relevant advantages over MI-PCF in terms of long-term revision rates despite an increased approach-related risk of transient postoperative dysphagia. Additionally, patients in the ACDR cohort achieved greater mean improvements in NDI scores but these results may have limited clinical significance due to inability to reach minimally clinically important difference (MCID) thresholds.

Keywords: Cervical disc replacement; cervical disc arthroplasty; minimally invasive spine surgery; posterior cervical foraminotomy, cervical radiculopathy.

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Comparing Outcomes Between Anterior Cervical Disc Replacement (ACDR) and Minimally Invasive Posterior Cervical Foraminotomy (MI-PCF) in the Treatment of Cervical Radiculopathy

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Abstract Background context: Anterior cervical disc replacement (ACDR) and minimally invasive posterior cervical foraminotomy (MI-PCF) have emerged as two increasingly popular alternatives to anterior cervical discectomy and fusion (ACDF) for the management of cervical radiculopathy. Both techniques provide advantages of segmental motion preservation and lower rates of adjacent segment degeneration (ASD) compared to ACDF. Purpose:

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