Posterior cervical foraminotomy after cervical disc arthroplasty

This study investigated clinical outcomes of posterior cervical foraminotomy (PCF) in patients who previously underwent cervical disc arthroplasty (CDA) at the same level. As CDA becomes more widely adopted and indications expand, a subset of patients will inevitably experience postoperative symptoms. PCF may provide symptomatic relief for persistent or recurrent radiculopathy without the need for revision arthroplasty or conversion to fusion.

A multicenter retrospective chart review was conducted, identifying a consecutive series of patients (n = 17) who received same-level PCF after CDA. Improvements after PCF in arm pain, neck pain, and Neck Disability Index (NDI) were tested using paired Wilcoxon signed-rank tests. The percentage of patients who met MCID for each outcome measure was calculated.

PCFs were performed at one (70.6%) or two (29.4%) levels. Average time from CDA to PCF was 87.4 weeks; average length of follow-up after PCF was 104.3 weeks. Arm and neck pain significantly improved respectively from an average of 5.1 and 4.9 preoperatively to 2.4 and 3.4 postoperatively (p = 0.008 and p = 0.011), with MCID respectively met by 75.0% and 68.8% of patients. NDI scores did not significantly change (p = 0.234). Post-operative instability was not encountered after PCF. Two patients (11.8%) underwent a reoperation after PCF involving removal of the artificial disc and conversion to anterior cervical fusion.

PCF was beneficial in the cohort overall without producing segmental instability or increasing complexity of necessary larger revision surgeries. PCF should be considered to address persistent or recurrent symptoms in patients with prior CDA.