Posterior foraminotomy or anterior discectomy with polymethyl methacrylate interbody stabilization for cervical soft disc disease:: Results in 292 patients with monoradiculopathy

Study Design. Retrospective study of patients who underwent either ventral microdiscectomy and polymethyl methacrylate (PMMA) interbody stabilization or posterior foraminotomy for the treatment of cervical monoradiculopathy caused by soft disc disease. Objectives. To evaluate the long-term outcome after 2 different surgical procedures in the treatment of cervical radiculopathy, compare them with each other and with previous data from other surgical techniques, and outline the indications, advantages, and disadvantages of each procedure. Summary of Background Data. Cervical disc disease can lead to morphologic different disc lesions, which again may differ in clinical presentation, operative treatment, and outcome. This study provides a clinical long-term follow-up of ventral and dorsal approaches. Methods. Follow-up evaluation (mean 72.1 +/- 25.9 months) after surgery of monoradicular symptoms was performed in 292 patients. Patients with hard disc disease, myelopathy, neoplasms, or traumatic or recurrent cervical disc disease were excluded. A total of 124 patients (42.5%) underwent ventral microdiscectomy and PMMA stabilization (group A), and in 168 patients (57.5%), a posterior foraminotomy was performed (group B). The outcome was determined according to Odom criteria based on a questionnaire or a telephone interview and was related to the following variables: morphologic findings, neurologic findings, duration of symptoms, operation technique applied, age, sex, and cervical level involved. Results. The success rate (Odom I + II) without consideration of morphologic findings was higher after anterior microdiscectomy with PMMA stabilization (93.6%) than after posterior foraminotomy (85.1%) (P < 0.05). The success rate was higher in cases with pure soft discs in both groups (A: 96.6%; B: 85.8%) than in cases with a mixture of soft and hard discs (A: 90.6%; B: 80%), without gaining statistical significance. Complications related to surgery occurred in 6.5% (group A) and 1.8% (group B) of patients (P < 0.05). Conclusion. The findings show that apparently a higher success rate results after anterior microdiscectomy with PMMA interbody stabilization for treatment of degenerative cervical monoradiculopathy than after posterior foraminotomy. Considering the type of morphology of the pathology that causes the radiculopathy, pure soft discs have a better outcome than mixtures of soft and hard discs, independent of the chosen approach. Although statistically significant differences in clinical data were found in both groups, both approaches seem to have equivalent value in individual indications.