Standalone Anterior Cervical Discectomy and Fusion Versus Combination with Foraminotomy for the Treatment of Cervical Spondylotic Radiculopathy Secondary to Bony Foraminal Stenosis.

Abstract

To compare the results of anterior cervical discectomy and fusion (ACDF) combined with anterior cervical foraminotomy (ACF) and standalone ACDF for the treatment of cervical spondylotic radiculopathy (CSR). The data of 24 consecutive patients who underwent ACDF combined with ACF for significant bony foraminal stenosis were reviewed. The clinical outcomes, including visual analog scale (VAS) scores for neck pain and arm pain and Neck Disability Index, were evaluated by questionnaires. Radiologic outcomes as manifested by C2-7 angle and surgical segmental angle were recorded. The outcomes were compared with outcomes of standalone ACDF for CSR secondary to posterolateral spurs. At the final follow-up evaluation, all patients obtained bone fusion. No patient developed adjacent segment disease. Operative time was longer and blood loss was more in the ACDF combined with ACF group than in the ACDF group (all P < 0.05). However, in both groups, the neck VAS score, arm VAS score, and Neck Disability Index were significantly reduced postoperatively (all P < 0.05). The segmental curve and C2-7 lordosis were significantly improved postoperatively (all P < 0.05). There was no significant difference between the 2 groups in clinical and radiologic outcomes (P > 0.05). For CSR with foraminal stenosis secondary to significant bony pathology that cannot be managed with standalone ACDF, ACDF combined with ACF is an effective and safe treatment strategy.