Reoperation and Perioperative Complications after Surgical Treatment of Cervical Radiculopathy: A Comparison between Three Procedures

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Journal Article

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STUDY DESIGN: A retrospective database study. OBJECTIVE: The purpose of our study was to compare the perioperative complications and reoperation rates after ACDF, CDA, and PCF in patients treated for cervical radiculopathy. SUMMARY OF BACKGROUND DATA: Cervical radiculopathy results from compression or irritation of nerve roots in the cervical spine. While most cervical radiculopathy is treated nonoperatively, anterior cervical discectomy and fusion (ACDF), cervical disc arthroplasty (CDA), and posterior cervical foraminotomy (PCF) are the techniques most commonly used if operative intervention is indicated. There is limited research evaluating the perioperative complications of these surgical techniques. METHODS: A retrospective review was performed using the PearlDiver Patient Record Database to identify cases of cervical radiculopathy that underwent ACDF, CDA, or PCF at 1 or 2 levels from 2007 to 2016. Perioperative complications and reoperations following each of the procedures were assessed. RESULTS: During the study period, 25,051 patients underwent ACDF, 522 underwent CDA, and 3,986 underwent PCF. After propensity score matching, each of the three groups consisted of 507 patients. Surgical site infection rates were highest after PCF (2.17%) compared with ACDF (0.20%) and CDA (0.59%) at 30-days and 3-months, P=0.003, P<0.001 respectively. New onset cervicalgia was highest following ACDF (34.32%) and lowest after PCF (22.88%) at 3- and 6-months, P<0.001 and P=0.003, respectively. Revision surgeries were highest among those who underwent CDA (6.90%) versus ACDF (3.16%) and PCF (3.55%) at 6-months, P=0.007. Limb paralysis was significantly higher after PCF compared to CDA and ACDF at 6-months, P<0.017. CONCLUSION: The rate of surgical site infection was higher in PCF compared to ACDF and CDA. New-onset cervicalgia was higher after ACDF compared to PCF and CDA at short term follow up. Revision surgeries were highest among those undergoing CDA and lowest in those undergoing ACDF. LEVEL OF EVIDENCE: 3.


Orthopaedic Surgery