title: Comparative Analysis between Total Disc Replacement and Posterior Foraminotomy for Posterolateral Soft Disc Herniation with Unilateral Radiculopathy : Clinical and Biomechanical Results of a Minimum 5 Years Follow-up.
abstract: OBJECTIVE
  To compare the clinical outcomes and biomechanical effects of total disc replacement (TDR) and posterior cervical foraminotomy (PCF) and to propose relative inclusion criteria.
  
  
  METHODS
  Thirty-five patients who underwent surgery between 2006 and 2008 were included. All patients had single-level disease and only radiculopathy. The overall sagittal balance and angle and height of a functional segmental unit (FSU; upper and lower vertebral body of the operative lesion) were assessed by preoperative and follow-up radiographs. C2-7 range of motion (ROM), FSU, and the adjacent segment were also checked.
  
  
  RESULTS
  The clinical outcome of TDR (group A) was tended to be superior to that of PCF (group B) without statistical significance. In the group A, preoperative and postoperative upper adjacent segment level motion values were 8.6±2.3 and 8.4±2.0, and lower level motion values were 8.4±2.2 and 8.3±1.9. Preoperative and postoperative FSU heights were 37.0±2.1 and 37.1±1.8. In the group B, upper level adjacent segment motion values were 8.1±2.6 and 8.2±2.8, and lower level motion values were 6.5±3.3 and 6.3±3.1. FSU heights were 37.1±2.0 and 36.2±1.8. The postoperative FSU motion and height changes were significant (p<0.05). The patient's satisfaction rates for surgery were 88.2% in group A and 88.8% in group B.
  
  
  CONCLUSIONS
  TDR and PCF have favorable outcomes in patients with unilateral soft disc herniation. However, patients have different biomechanical backgrounds, so the patient's biomechanical characteristics and economic status should be understood and treated using the optimal procedure.
authors.affiliation: Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea.
authors.forename: Kyoung-Tae
authors.initials: KT
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea.
authors.forename: Dae-Chul
authors.initials: DC
authors.lastname: Cho
authors.affiliation: Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea.
authors.forename: Joo-Kyung
authors.initials: JK
authors.lastname: Sung
authors.affiliation: Department of Neurosurgery, Chung-Ang University Hospital, Seoul, Korea.
authors.forename: Young-Baeg
authors.initials: YB
authors.lastname: Kim
authors.affiliation: Department of Rehabilitation Medicine, Keimyung University Hospital, Daegu, Korea.
authors.forename: Du Hwan
authors.initials: DH
authors.lastname: Kim
keywords: Cervical disc; Foraminotomy; Radiculopathy; Total disc replacement