Author(s): Konteas A.B.; Carleton-Bland N.; Lee M.; Clark S.; Wilby M.
Source: European Spine Journal; 2017; vol. 26 (no. 2)
Publication Date: 2017
Publication Type(s): Conference Abstract
Available at European Spine Journal – from SpringerLink – Medicine
Abstract:Background context: Cervical radicular compression is a commonly encounter condition in spinal surgical practice. Radiculopathy is debilitating with recognised affects on social functioning and quality of life. Surgical treatment aims to decompress the root via either anterior cervical discectomy (”ACDF”) or posterior cervical foramenotomy (”PCF”). The choice of which surgical strategy is controversial, as there is little conclusive evidenced opinion comparing efficacy or sequelae of these approaches using validated outcome measures. Purpose: To compare PCF and ACDF with a validated outcome measure to allow comparison of the two techniques. Study: Review of a single centre prospectively collected COMI data on ACDF and PCF performed between 2012 and 2014 Outcome measure: Self-reported Core Outcome Measurement Index (”COMI”) at 0,3,12 and 24 month post procedure. Methods: Eight surgeons were involved in the allocation of either anterior or posterior surgery as was the surgeon’s preference. All candidates were contemporaneously COMI assessed. Data acquisition was at clinic appointment or via postal methods. Results: Complete datasets were acquired in 49 PCF (41M22F) and 262 ACDF (M F). For ACDF COMI-mean scores: 7.6 (0 months)-5.1(3 months)-4.2 (12 months). For PCF COMI-mean scores: 7.2(0 months)-5.6(3 months)- 4.7(12 months). Significant complication rate was 3%. Patient reported outcome measures are also discussed. Conclusion: COMI scores suggest similar efficacy of the two procedures; both procedure produce a clinical and statistically significant improvement. Notably patients who have undergone PCF reach their maximal improvement at 3 months. This is in contrast to ACDF patients, who continue to improve up to 12 months post procedure. Interpretation is that sub-optimally treated radiculopathy in the ACDF group can be treated conservatively as there is statistically significant improvement up to a year post procedure. Of interest the patient reported outcome measures (”PROMS”) gave a complication rate of 30% as compared to a clinical complication rate of 3%, indicating need for improvement in patient consent processes. Strengths of this study are the use of a validated assessment tool with large groups and ample follow up period. Limitations include incomplete COMI data, lack of blinding and group size disparity. (Figure Presented).