From the Guidelines
The anterior approach for cervical radiculopathy generally has a lower overall complication rate compared to the posterior approach, with complication rates ranging from 4-8% for anterior cervical discectomy and fusion (ACDF) versus 9-14% for posterior approaches like foraminotomy. When considering the treatment of cervical radiculopathy, the choice between an anterior and posterior surgical approach is crucial, as it directly impacts the patient's morbidity, mortality, and quality of life. The anterior approach is typically preferred for its lower complication rate and better access to the disc space, allowing for more direct decompression and fusion, as noted in studies such as 1. Common complications for the anterior approach include dysphagia, hoarseness, and rarely, esophageal or tracheal injury, whereas the posterior approach may lead to neck pain, C5 palsy, and cerebrospinal fluid leak, as discussed in 1. Key factors influencing the choice between approaches include the location and number of affected levels, patient anatomy, and surgeon experience. Surgeons should weigh individual patient factors and the specific pathology when deciding between approaches, considering that the anterior approach offers potentially faster recovery times and less postoperative pain due to its more direct access to the pathology and less muscle dissection. In the context of real-life clinical medicine, prioritizing the patient's safety and well-being, the anterior approach is generally recommended for single-level radiculopathy due to its lower complication rate and faster recovery times, as supported by the most recent and highest quality evidence available, such as 1 and 1.
From the Research
Complication Rates of Anterior and Posterior Approaches
- The complication rate for anterior cervical discectomy and fusion (ACDF) was reported to be around 7% in one study 2, while another study found no statistically significant difference in complication rates between ACDF and posterior cervical foraminotomy (PCF) 3.
- A systematic review found that the mean complication rate was 7% in the ACDF group and 4% in the PCF group 2.
- A retrospective single-center series found that both ACDF and PCF had comparable early complication rates, but PCF patients tended to have more late reoperations 4.
Comparison of Anterior and Posterior Approaches
- A study comparing ACDF, PCF, and cervical disk arthroplasty (CDA) found that all four treatment options conferred good clinical results for cervical radiculopathy, with low and comparable intraoperative and postoperative complications 3.
- Another study found that PCF was just as safe and effective as ACDF in the treatment of cervical radiculopathy, with potentially lower medical costs and a decreased incidence of adjacent segment disease 2.
- A retrospective analysis of 107 patients found that patients in the PCF group reported better overall outcome and greater relief of radicular and neck pain, with less operative time and blood loss 4.
Indications for Anterior and Posterior Approaches
- ACDF is generally preferred for radiculopathy with significant axial neck pain, central disease, or segmental kyphosis 5.
- PCF is an acceptable choice for lateral soft disk herniations with predominant arm pain and for caudal lesions in large, short-necked individuals 5.
- The posterior approach is preferable for lateral or foraminal nerve root compression, while the anterior approach is better suited for central, broad-based, and anterior abnormalities 6.