title: Reoperation rates after anterior cervical discectomy and fusion versus posterior cervical foraminotomy: a propensity-matched analysis.
abstract: BACKGROUND
  Anterior cervical discectomy and fusion (ACDF) and posterior cervical foraminotomy (PCF) are both used to surgically treat patients with cervical radiculopathy and have been shown to have similar outcomes. Nonetheless, ACDF has become increasingly more commonplace compared with PCF, in part because of a pervasive belief that PCF has a higher incidence of required reoperations.
  
  
  OBJECTIVE
  To determine the reoperation rate at the index level of ACDF versus PCF 2 years postoperatively.
  
  
  METHODS
  A retrospective case-control.
  
  
  METHODS
  All patients that underwent ACDF and PCF for radiculopathy (excluding myelopathy indications) between January 2005 and December 2011.
  
  
  METHODS
  Revision surgery within 2 years, at the index level, was recorded.
  
  
  METHODS
  Propensity score analysis between the ACDF and PCF groups was done, matching for age, gender, race, body mass index, tobacco use, median income and insurance status, primary surgeon, level of surgery, surgery duration, and length of hospital stay.
  
  
  RESULTS
  Seven hundred ninety patients met the inclusion/exclusion criteria, including 627 ACDF and 163 PCF. Before propensity matching, the PCF group was found to be significantly older and more likely to be male. After matching, there were no significant differences between groups for any baseline characteristics. Reoperation rate at the index level was 4.8% for the ACDF group and 6.4% for the PCF group (p=.7) within 2 years of the initial surgery. Using equivalence testing, based on an a priori null hypothesis that a clinically meaningful difference between the two groups would be ≥5%, we found that the absolute difference of 1.6% was significantly (p=.01) less than our hypothesized difference.
  
  
  CONCLUSIONS
  This study demonstrates that even after accounting for patient demographics, operative characteristics, and primary surgeon, there are no significant differences in 2-year reoperation rates at the index level between ACDF and PCF. The reoperation rates are statistically equivalent. Thus, spine surgeons can operate via the posterior approach without putting patients at increased risk for revision surgery at the index level.
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Neurosurgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lubelski
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Neurosurgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Healy
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Silverstein
authors.affiliation: Department of Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
authors.forename: Kalil G
authors.initials: KG
authors.lastname: Abdullah
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
authors.forename: Nicolas R
authors.initials: NR
authors.lastname: Thompson
authors.affiliation: Washington University Orthopedics, Washington University School of Medicine, 4921 Parkview Pl, St. Louis, MO 63110, USA.
authors.forename: K Daniel
authors.initials: KD
authors.lastname: Riew
authors.affiliation: Department of Neurological Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, 11100 Euclid Avenue, HAN 5042 Cleveland, OH 44106, USA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Steinmetz
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Neurosurgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
authors.forename: Edward C
authors.initials: EC
authors.lastname: Benzel
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, 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 / Q000706:statistics & numerical data*; D005260:Female; D059526:Foraminotomy / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011843:Radiculopathy / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: Anterior cervical discectomy and fusion; Cervical radiculopathy; Foraminal stenosis; Posterior cervical foraminotomy; Propensity matching; Reoperation rates