title: Anterior cervical discectomy and fusion versus posterior cervical foraminotomy in the treatment of brachialgia: the Leeds spinal unit experience (2008-2013).
abstract: BACKGROUND
  The surgical management of cervical brachialgia utilising anterior cervical discectomy and fusion (ACDF) or posterior cervical foraminotomy (PCF) is a controversial area in spinal surgery. Previous studies are limited by utilisation of non-validated outcome measures and, importantly, absence of pre-operative analysis to ensure both groups are matched. The authors aimed to compare the effectiveness of ACDF and PCF using validated outcome measures. To our knowledge, it is the first study in the literature to do this.
  
  
  METHODS
  The authors conducted a 5-year retrospective review (2008-2013) of outcomes following both the above procedures and also compared the effectiveness of both techniques. Patients with myelopathy and large central discs were excluded. The main outcome variables measured were the neck disability index (NDI) and visual analogue scores (VAS) for neck and arm pain pre-operatively and again at 2-year follow-up. The Wilcoxon signed-rank test and Student t-tests were used to test differences.
  
  
  RESULTS
  A total of 150 ACDFs and 51 PCFs were performed for brachialgia. There was no differences in the pre-operative NDI, VAS neck and arm scores between both groups (p > 0.05). As expected, both ACDF and PCF delivered statistically significant improvement in NDI, VAS-neck and VAS-arm scores. The degree of improvement of NDI, VAS-neck and VAS-arm were the same between both groups of patients (p > 0.05) with a trend favouring the PCF group. In the ACDF group, two (1.3 %) patients needed repeat ACDF due to adjacent segment disease. One patient (0.7 %) needed further decompression via a foraminotomy. In the PCF group one (2.0 %) patient needed ACDF due to persistent brachialgia.
  
  
  CONCLUSIONS
  We found both interventions delivered similar improvements in the VAS and NDI scores in patients. Both techniques may be appropriately utilised when treating a patient with cervical brachialgia.
authors.affiliation: Department of Neurosurgery, Leeds General Infirmary, LS1 3EX, Leeds, UK, Senthil-kumar@doctors.org.uk.
authors.forename: Senthil K
authors.initials: SK
authors.lastname: Selvanathan
authors.forename: Chris
authors.initials: C
authors.lastname: Beagrie
authors.forename: Simon
authors.initials: S
authors.lastname: Thomson
authors.forename: Rob
authors.initials: R
authors.lastname: Corns
authors.forename: Kenan
authors.initials: K
authors.lastname: Deniz
authors.forename: Chris
authors.initials: C
authors.lastname: Derham
authors.forename: Gerry
authors.initials: G
authors.lastname: Towns
authors.forename: Jake
authors.initials: J
authors.lastname: Timothy
authors.forename: Deb
authors.initials: D
authors.lastname: Pal
mesh_terms: D000328:Adult; D019299:Decompression, Surgical / Q000009:adverse effects*; D017586:Diskectomy / Q000009:adverse effects*; D005260:Female; D059526:Foraminotomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011843:Radiculopathy / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects*; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data; D006113:United Kingdom