From the Guidelines
For cervical radiculopathy, the anterior approach is generally preferred over the posterior approach. The anterior cervical discectomy and fusion (ACDF) is the most common surgical procedure for this condition. It involves making a small incision in the front of the neck, removing the problematic disc, and fusing the vertebrae. This approach offers several advantages: it provides direct access to the disc space, allows for thorough decompression of the nerve root, and typically results in less postoperative pain and faster recovery compared to the posterior approach.
Key Considerations
- The anterior approach avoids disruption of the posterior neck muscles, which can lead to less postoperative pain and stiffness.
- However, the choice between anterior and posterior approaches should be individualized based on the patient's specific pathology, the number of levels involved, and the surgeon's expertise.
- In cases where the compression is primarily posterior or involves multiple levels, a posterior approach might be considered, as noted in the context of decompressing an epidural abscess via a posterior approach, although with caution, especially in the presence of substantial vertebral body destruction 1.
Postoperative Care and Recovery
- Patients undergoing ACDF typically stay in the hospital for 1-2 days and can expect a recovery period of 4-6 weeks before returning to normal activities, with full fusion occurring over several months.
- The use of substances that promote bone growth, such as tricalcium phosphate derivatives or bone morphogenic protein, can supplement the fusion process without specific contraindications, even in the presence of bacterial spondylitis, as per the guidelines for treating conditions like coccidioidomycosis 1.
From the Research
Treatment Approaches for Cervical Radiculopathy
The treatment of cervical radiculopathy can be approached through either anterior or posterior methods, with the choice depending on the specific cause and severity of the condition.
- Anterior approaches include anterior cervical discectomy and fusion (ACDF) 2, 3, which allows for direct decompression of the nerve root and can be effective in treating conditions such as disc herniation and bony foraminal stenosis.
- Posterior approaches, such as posterior cervical foraminotomy, are also used to treat cervical radiculopathy, particularly in cases where the condition is caused by bony foraminal stenosis or other posterior compression 4.
Anterior Approach Techniques
Several studies have investigated the effectiveness of anterior approach techniques for treating cervical radiculopathy.
- A study published in 2020 found that ACDF with uncinectomy allowed for complete and direct decompression of the exiting nerve root, leading to improved clinical outcomes in selected patients 2.
- Another study published in 2006 described a microsurgical cervical nerve root decompression technique using an anterolateral approach, which permitted minimal disc and bone resections and avoided osteoarthrodesis or arthroplasty with disc prosthesis 5.
- A systematic review published in 2009 identified ACDF and anterior cervical discectomy as equivalent treatment strategies for 1-level disease, with ACDF achieving a more rapid reduction of neck and arm pain and reducing the risk of kyphosis 3.
Posterior Approach Techniques
While the provided studies focus primarily on anterior approaches, posterior approaches are also recognized as effective treatments for cervical radiculopathy.
- A review published in 2011 noted that posterior cervical laminoforaminotomy is a surgical treatment option for cervical radiculopathy, particularly in cases where the condition is caused by posterior compression 4.
Recent Developments and Case Reports
Recent studies have explored the use of anterior cervical foraminotomy (ACF) as a technique for treating radiculopathy after cervical artificial disc replacement (ADR).
- A case report published in 2022 described the use of ACF to provide symptom relief in patients with persistent or recurrent radicular symptoms after ADR, without the need to convert to a fusion or remove the ADR implant 6.