title: Rates of anterior cervical discectomy and fusion after initial posterior cervical foraminotomy.
abstract: BACKGROUND
  In select patients, posterior cervical foraminotomy (PCF) and anterior cervical discectomy and fusion (ACDF) result in similar clinical outcomes when used to treat cervical radiculopathy. Nonetheless, ACDF is performed more frequently, in part because of surgeon perception that PCF requires operative revisions more frequently. The present study investigates the rate of ACDF reoperation at the index level after initial PCF.
  
  
  OBJECTIVE
  To determine the rate of ACDF after initial PCF and to further describe any patient characteristics or preoperative or operative data that increase the rate of reoperation after PCF.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Demographic, operative, and reoperation information was collected from the electronic medical records for all patients who underwent PCF at one institution between 2004 and 2011. All patients were subsequently contacted by telephone to identify postoperative complications and more conclusively determine whether any revision operation was performed at the index level.
  
  
  RESULTS
  One hundred seventy-eight patients who underwent a PCF were reviewed, with an average follow-up of 31.7 months. Nine (5%) patients underwent an ACDF revision operation at the index level. The reason for reoperation in these patients included cervical radiculopathy, foraminal stenosis, disc herniation, and cervical spondylosis. Patients who subsequently underwent ACDF at the index level were significantly younger (25 vs. 35 years, p=.03), had lower body mass index (25 vs. 29, p=.01), and more likely to take anxiolytic (56% vs. 22%, p=.04) or antidepressant medication (67% vs. 27%, p=.02), compared with those that did not have a revision operation.
  
  
  CONCLUSIONS
  This is the first study to determine conversion to ACDF after PCF. The present study demonstrates that PCF is associated with a low reoperation rate, similar to the historical reoperation for ACDF. Accordingly, spine surgeons can operate via a PCF approach without a significant increased risk for ACDF revision surgery at the index level.
authors.affiliation: Duke University School of Medicine, DUMC 3710, Durham, NC 27710, USA; Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA.
authors.forename: Timothy Y
authors.initials: TY
authors.lastname: Wang
authors.affiliation: Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA; Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lubelski
authors.affiliation: Department of Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, USA.
authors.forename: Kalil G
authors.initials: KG
authors.lastname: Abdullah
authors.affiliation: School of Medicine, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA; Department of Neurosciences, MetroHealth Medical Center, 2500 Metrohealth Dr, Cleveland, OH 44109, USA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Steinmetz
authors.affiliation: Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA; Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA.
authors.forename: Edward C
authors.initials: EC
authors.lastname: Benzel
authors.affiliation: Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA; Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA. Electronic address: mrozt@ccf.org.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Mroz
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D017586:Diskectomy / Q000009:adverse effects*; D005260:Female; D059526:Foraminotomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011843:Radiculopathy / Q000601:surgery; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects*; D055009:Spondylosis / Q000601:surgery; D016896:Treatment Outcome
keywords: Anterior cervical discectomy and fusion; Cervical spine; Posterior cervical foraminotomy; Revision rate