Evaluation of Current Trends in Treatment of Single-level Cervical Radiculopathy

Presented at SMISS Annual Forum 2018
By Jung Mok
With Evan Sheha MD, Andre Samuel MD, Steven McAnany MD, Avani Vaishnav MBBS, Todd Albert MD, Catherine Gang MPH, Sheeraz Qureshi MD, MBA,

Disclosures: Jung Mok None Evan Sheha MD None, Andre Samuel MD None, Steven McAnany MD None, Avani Vaishnav MBBS None, Todd Albert MD B; Depuy, Biomet, Nuvasive, FacetLink. D; Vertech, In Vivo Therapeutics, Paradigm Spine, Biomerix, Breakaway Imaging, Crosstree, Invulty, Pioneer, Gentis, ASIP, PMIG. F; Depuy, Biomet, Nuvasive, Catherine Gang MPH None, Sheeraz Qureshi MD, MBA A; Cervical Spine Research Society. B; Zimmer-Biomet, Stryker Spiner, Globus Medical, Inc. D; Avaz Surgical. F; RTI, Zimmer-Biomet, Stryker Spine,

Introduction:

Single-level cervical radiculopathy (SLCR) that fails non-operative management is effectively treated with anterior cervical discectomy and fusion (ACDF), cervical disc replacement (CDR), or posterior cervical foraminotomy (PCF). While studies have shown that all three options are clinically effective, trends in usage, differences in patient population, and differences in complications remain unknown.

Aims/Objectives:

To identify epidemiological trends, differences, and complications in patients undergoing surgical treatment for SLCR.

Methods:

Patients who underwent either ACDF, CDR, or PCF in the treatment of SLCR from 2010-2016 were retrospectively reviewed using the NSQIP database. Demographic data consisted of patient sex, age, ASA class, BMI, and inpatient/outpatient status. Complications included surgical site infection, pneumonia, reintubation, PE, DVT, readmissions, reoperations, operating time, and hospital length of stay. Utilization trends by year among the three procedures were also analyzed.

Results:

A total of 1102 patients with SLCR treated with single-level ACDF, CDR, or PCF were identified in NSQIP from 2010-2016. There was a relative increase in the number of CDR procedures and a corresponding decrease in PCF procedures without a significant effect on ACDF procedures. Patients who underwent CDR were younger and in a lower ASA class than those undergoing ACDF or PCF. Patients undergoing PCF were significantly more likely to be treated as an outpatient. PCF procedures also had the shortest total operating time and the shortest total hospital length of stay. There were no significant differences in complications among the three procedures. Moreover, there were no significant trends in demographics or outcome measures.

Conclusions:

ACDF remains the most common surgical treatment for patients with SLCR, and its utilization has remained consistent. Meanwhile, the increased utilization of CDR for the treatment of SLCR has resulted in a corresponding decrease in the utilization of PCF.