Longer-term data needed to fully assess potential superiority of minimally invasive posterior cervical foraminotomy

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Andrew Platt

There is no clear superiority between minimally invasive posterior cervical foraminotomy (MIS-PCF) and either anterior cervical discectomy and fusion (ACDF) or cervical total disc arthroplasty (TDA) in relation to operative time, postoperative length of stay, rate of complications or rate of reoperations. This is the key finding of a recent meta-analysis published in the Global Spine Journal by Andrew Platt (Rush University Medical Centre, Chicago, USA) et al.

The researchers note however that further studies with increased follow-up intervals and higher sample sizes are “necessary to determine the true superiority of MIS-PCF and anterior neck approaches in treatment of lateral disc and foraminal pathology”.

Speaking to Spinal News International, Platt said: “MIS-PCF has many potential advantages over ACDF when used for lateral disc herniations and unilateral radiculopathy. Although there is a lack of comparative data in the literature, large series with follow-up greater than four years may show superiority of MIS-PCF especially in comparison to the reoperation rate at adjacent levels.”

The study included a systematic review of the literature and meta-analysis of studies directly comparing MIS-PCF to either ACDF or cervical TDA. Online databases PubMed, the Cochrane Library, and Scopus, were used to identify clinical studies comparing the different procedures.

The meta-analysis found that operative time ranged from 68 to 97.8 minutes in the ACDF group compared to 28 to 93.9 minutes in the MIS-PCF group. Mean postoperative length of stay ranged from 33.84 to 112.8 hours in the ACDF group compared to 13.68 to 83.6 hours in the MIS-PCF group. Total complication rates were 3.72% in the ACDF group and 3.73% in the MIS-PCF group. A random-effects model meta-analysis was also carried out which failed to show a statistically significant difference in the complication rate between the two procedures (odds ratio [OR] 0.91; 95% confidence interval [CI] 0.13, 6.43; p=0.92, I2=59%).

The total reoperation rate was 3.5% in the ACDF group and 5.4% in the MIS-PCF group. A random-effects model meta-analysis was carried out which failed to show a statistically significant difference in the reoperation rate between the two procedures (OR 0.66; 95% CI 0.33, 1.33; p=0.25, I2=0).

In comparing patients undergoing TDA and MIS-PCF, operative time ranged from 90.3 to 106.7 minutes in the TDA group compared to 77.4 to 93.9 minutes in the MIS-PCF group. Mean postoperative length of stay ranged from 103.2 to 165.6 hours in the TDA group and 93.6 to 98.4 hours in the MIS-PCF group. The complication rate ranged from 23.5 to 28.6% in the TDA group and 0 to 14.3% in the MIS-PCF group. The overall reoperation rates were 2.6% in the TDA group and 10.2% in the MIS-PCF group.


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