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• W2895555841 abstract "BACKGROUND CONTEXT Minimally-Invasive Posterior Cervical Foraminotomy (mis-PCF) has proven effective in addressing symptoms of cervical radiculopathy and foraminal stenosis in appropriately indicated patients. Few studies have compared the revision rates and outcome scores of the procedure directly to ACDF however, and have been limited to 2-year of postoperative follow-up. Additionally, none of these studies have utilized a minimally-invasive technique with tubular decompression. While the advantages of mis-PCF are numerous and well-documented in the literature (no hardware, shortened length of stay and return to work, reduced blood loss, pain medication use and overall cost), there is concern that the revision rate will increase substantially as patient's follow-up increases beyond 2-years. If the majority of patients treated with mis-PCF are eventually treated with an ACDF, the cost analysis of both the procedure and return to work will need to be reevaluated. Therefore, in order to better understand the consequences of choosing mis-PCF over ACDF in certain patients, studies with long term follow-up must be conducted. PURPOSE To assess the long-term clinical efficacy and revision rates of mis-PCF with tubular decompression compared to ACDF for the treatment of cervical radiculopathy without myelopathy refractory to conservative treatment STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE A total of 210 patients who underwent ACDF and 49 patients who underwent mis-PCF at a single institution. OUTCOME MEASURES Primary outcome measures were re-operation proportions; overall, at the index and adjacent levels. Secondary outcome measures were functional outcome scores; Neck Disability Index (NDI), Visual Analog Scale Arm (VAS-a) and Visual Analog Scale Nek (VAS-n). METHODS From 2009 to 2014, 210 consecutive patients underwent ACDF and 49 underwent mis-PCF for cervical radiculopathy without myelopathy refractory to conservative treatment and a minimum of 2-year follow-up were compared in separate cohorts. mis-PCF patients had a mean follow-up was 42.9 months while ACDF patients had 44.9 months. Demographic variables of cohorts were compared. Revisions and complications were reviewed and compared. Functional outcomes were assessed with NDI and VAS-a and VAS-n measurements preoperatively and at each follow-up visit. Standard binomial and categorical comparative analysis was performed. RESULTS There was no difference found in proportion of revisions between mis-PCF and ACDF cohorts (4 of 29, 8.2% vs. 12 of 210, 5.7%, p=.514, respectively). There was no difference found in revision rate per level per year (3.1 vs. 1.7, p=.464). Likewise, there was no difference found in revision rate per level per year at the index level (1.8 vs. 0.7, p=.466) or at an adjacent level (1.3 vs. 1.1, p=.906). No difference was found between cohorts in regards to change from pre-op to final post-op functional outcome scores (NDI, VAS-a and VAS-n).There was 1 (2.7%) complication in the mis-PCF cohort (postoperative hematoma) and 7 (3.3%) complications in the ACDF cohort. CONCLUSIONS Minimally-invasive posterior cervical foraminotomy compared directly to ACDF, with a mean follow-up of nearly 43 months, has demonstrated similar revision proportions, rates, and functional outcome scores. Future studies with minimum 5 and 10 years follow-up comparing the procedures are still warranted to conclusively determine the utility of the mis-PCF technique with tubular decompression and its ability to prevent unwanted fusions. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs." @default.
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• W2895555841 date "2018-08-01" @default.
• W2895555841 modified "2023-10-06" @default.
• W2895555841 title "Wednesday, September 26, 2018 1:00 PM – 2:00 PM What's New in MIS" @default.
• W2895555841 doi "https://doi.org/10.1016/j.spinee.2018.06.048" @default.
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