Factors Associated With Failure of Symptomatic Relief After Single-Level Posterior Cervical Foraminotomy for...

Posterior cervical foraminotomy (PCF) is a motion-sparing treatment for cervical radiculopathy with rates of symptomatic pain relief similar to anterior cervical diskectomy in patients with persistent symptoms despite nonsurgical management. Although the operation is effective in well-selected patients, some who undergo PCF do not show significant symptomatic improvement, and objective radiographic parameters to identify these patients would assist with operative planning. We sought to determine the radiographic, demographic, and operative factors that are associated with failure to achieve the minimum clinically important difference (MCID) in visual analog scale neck or arm pain after PCF.

This was a retrospective case-control study at a tertiary academic center. All adult patients undergoing single-level PCF for unilateral radicular arm or neck pain were identified, and their preoperative imaging, comorbidities, physical examination, and postoperative outcomes were reviewed. Patients undergoing additional concurrent procedures were excluded. Radiographic parameters included disk space height, foraminal and nerve root dimensions, and facet joint degeneration. Univariate and multivariate logistic regression analyses were performed to identify characteristics associated with the primary outcome, failure to reach the MCID in visual analog scale arm or neck pain, based on presenting symptom.

A total of 106 patients met criteria for analysis, of whom 77 (72.6%) met the MCID for symptomatic relief, and 29 (27.4%) did not. Multivariate regression revealed factors associated with achieving the MCID were increasing disk space height, increasing foraminal height, and increasing extraforaminal nerve root width. Factors negatively associated with achieving the MCID included smoking and increasing number of reported allergies.

In this retrospective analysis, disk height loss was independently associated with lower rates of symptomatic relief after foraminotomy. Given that this is a surgically modifiable parameter, surgeons may instead opt for anterior cervical diskectomy followed by fusion or arthroplasty in this specific patient population.