What is the complication rate of anterior versus posterior approach for cervical radiculopathy (Cervical Radiculopathy)?

From the Guidelines

The anterior approach for cervical radiculopathy generally has a lower complication rate compared to the posterior approach, with typical complication rates ranging from 4-8% for the anterior approach and 7-11% for the posterior approach.

Complications of Anterior Approach

The anterior approach is associated with complications such as dysphagia (difficulty swallowing), dysphonia (voice changes), and rarely, esophageal or tracheal injury, as reported in studies such as 1.

• Dysphagia is a common complication, with rates ranging from 1-5%
• Dysphonia, or voice changes, can occur in up to 50% of patients immediately following anterior cervical spine surgery, although this may resolve over time 1
• Esophageal or tracheal injury is a rare but serious complication

Complications of Posterior Approach

In contrast, the posterior approach may lead to more neck pain, C5 palsy, and a higher risk of cerebrospinal fluid leak, as noted in studies such as 1.

• Neck pain is a common complication, with rates ranging from 10-20%
• C5 palsy is a rare but serious complication, with rates ranging from 1-5%
• Cerebrospinal fluid leak is a rare but serious complication, with rates ranging from 1-5%

Choice of Approach

The choice between anterior and posterior approaches should be individualized based on the patient's specific pathology, number of levels involved, and surgeon expertise, as the most recent and highest quality study 1 suggests that posterior approaches are typically more painful and have a higher risk of poor wound healing and wound infection.

• In some cases, such as multilevel posterior compression or when the pathology is primarily posterior, a posterior approach may be more appropriate despite the slightly higher complication rate
• However, the anterior approach is often preferred due to its lower complication rate and better access to the disc space and foramina, allowing for direct decompression of the nerve root and spinal cord, and is particularly useful for addressing disc herniations and osteophytes 1

From the Research

Complication Rate of Anterior versus Posterior Approach for Cervical Radiculopathy

• The complication rate of anterior versus posterior approach for cervical radiculopathy is not explicitly stated in the provided studies, but the advantages and disadvantages of each approach are discussed 2, 3, 4, 5, 6.
• Anterior cervical discectomy and fusion (ACDF) has been widely used and proven to be safe and effective, but it may be associated with complications such as adjacent segment disease 2.
• Posterior cervical foraminotomy is a safe and effective surgical option that can avoid complications associated with anterior approach and fusion surgery 2, 5, 6.
• Minimally invasive anterior foraminotomy is a surgical option that can provide direct nerve root decompression in cervical radiculopathy without requiring cervical fusion 4.
• Anterior endoscopic cervical discectomy (AECD) is a minimally invasive procedure that can reduce surgical complications and tissue damage, but high-quality clinical studies are needed to verify its effectiveness 3.

Surgical Approaches for Cervical Radiculopathy

• Anterior approach:
  • Indications: significant component of axial neck pain, centrally located disease, segmental kyphosis 5.
  • Techniques: ACDF, AECD, minimally invasive anterior foraminotomy 2, 3, 4.
• Posterior approach:
  • Indications: lateral soft disk herniations, predominant arm pain, caudal lesions in large, short-necked individuals 5, 6.
  • Techniques: posterior laminoforaminotomy, posterior cervical foraminotomy 5, 6.