Noninferiority of Posterior Cervical Foraminotomy vs Anterior Cervical Discectomy With Fusion for Procedural Success and Reduction in Arm Pain Among Patients With Cervical Radiculopathy at 1 Year

• DOI: 10.1001/jamaneurol.2022.4208
• Publication Date: 2022-11-21T16:31:55Z
• Authors: Anne E. H. Broekema; Nádia F. Simões d...; Remko Soer; Jan Koopmans; Henk van Santbrink; Mark P. Arts; Bachtiar Burhani; Ronald H. M. A. B...; Niels A. van der ...; Martijn H. P. Ver...; Katalin Tamási; J. Marc C. van Dijk; Michiel F. Reneman; Rob J. M. Groen; Jos M. A. Kuijlen; ; Paul Plas; Menno R Germans; Susan van Kuijk; Kim Rijkers; Regina Giepmans; Robin van Zijl; Irene van Beelen; Norbert Höss; Terry Bruggink; Paula van Limpt-V...; Antoinette D I va...; Diane H Steenks; Gezina AT Lesman-...
• Keywords: Foraminotomy; Cervical radiculopathy; Neck pain; Radicular pain; Discectomy

The choice between posterior cervical foraminotomy (posterior surgery) and anterior discectomy with fusion (anterior for foraminal radiculopathy remains controversial.To investigate the noninferiority of vs surgery in patients regard to clinical outcomes after 1 year.This multicenter investigator-blinded randomized trial was conducted from January 2016 May 2020 a total follow-up 2 years. Patients were included 9 hospitals Netherlands. Of 389 adult 1-sided single-level screened eligibility, 124 declined participate or did not meet eligibility criteria. pure axial neck pain without radicular eligible. 265 (132 133 anterior), 15 lost 228 1-year analysis (110 118 anterior).Patients randomly assigned 1:1 fusion.Primary proportion success using Odom criteria decrease arm visual analogue scale 0 100 margin 10% (assuming advantages over that would justify tolerable loss efficacy 10%). Secondary pain, disability, quality life, work status, treatment satisfaction, reoperations, complications. Analyses performed 2-proportion z tests at .05 significance levels Bonferroni corrections.Among patients, mean (SD) age 51.2 (8.3) years; (50%) female 132 male. (132) (133) surgery. 0.88 (86 98) group 0.76 (81 106) (difference, -0.11 percentage points; 95% CI, -0.01) between-group difference -2.8 (1-sided -9.4) follow-up, indicating Decrease had 3.4 11.8), crossing 1.8 points. All secondary 2-sided CIs clustered around small differences.In this trial, noninferior regarding rate year. differences. These results may be used enhance shared decision-making.Netherlands Trial Register Identifier: NTR5536.