A large-scale database comparison of contemporary surgical complications in cervical radiculopathy: Cervical disc...

Anterior Cervical Discectomy and Fusion (ACDF) has been the gold-standard surgical treatment for cervical radiculopathy. However, advancements in the motion-preserving alternatives Cervical Disc Replacement (CDR) and Posterior Cervical Foraminotomy (PCF) necessitate a contemporary comparison of their effectiveness and safety profiles. To address this, we performed a national database study to compare postoperative complication rates between CDR and PCF for cervical radiculopathy patients.

Patients who underwent a one-level CDR or PCF from 2017 to 2022 and diagnosis of cervical radiculopathy within one year prior to their surgery were included. The study cohorts were identified based on ICD 9/10 and CPT codes. The CDR cohort was matched to the PCF cohort in a 1:1 ratio by age, gender, and Charlson Comorbidity Index (CCI) score. Outcomes evaluated included 90-day medical and surgical complications, revision surgeries, emergency department visits, and hospital readmissions.

4504 patients were matched in each cohort. Patients who underwent a CDR had higher rates of dysphagia (2.2 % vs. 1.1 %, p < 0.001) and dysphonia (0.4 % vs. 0.2 %, p = 0.001). However, the CDR group exhibited lower rates of dural tear (0.0 % vs. 0.3 %, p = 0.006), wound dehiscence (0.5 % vs. 1.4 %, p < 0.001), seroma (0.1 % vs. 0.4 %, p = 0.003), deep wound infection (0.4 % vs. 1.7 %, p < 0.001), superficial wound infection (0.2 % vs. 0.6 %, p = 0.002), and cervical revision surgery (0.6 % vs. 2.2 %, p < 0.001). Additionally, CDR patients demonstrated a lower hospital readmission rate (1.3 % vs. 2.7 %, p < 0.001) and 90-day emergency department visit rate (9.5 % vs. 10.9 %, p = 0.074).

While CDR may offer a more favorable complication profile overall, PCF remains a valuable alternative for patients at elevated risk for anterior approach-related morbidity. Future studies should include detailed clinical and radiographic factors to better identify predictors of surgical complications and improve procedure selection guidelines.