Percutaneous uniportal versus biportal endoscopic posterior cervical foraminotomy for unilateral cervical radiculopathy with cervical foraminal disc disease

Object Patients suffering from cervical radiculopathy in whom a course of nonoperative treatment has failed are often candidates for a single-level anterior cervical discectomy and fusion (ACDF) or posterior cervical foraminotomy (PCF). The objective of this analysis was to identify any significant cost differences between these surgical methods by comparing direct costs to the hospital. Furthermore, patient-specific characteristics were also considered for their effect on component costs. Methods After obtaining approval from the medical center institutional review board, the authors conducted a retrospective cross-sectional comparative cohort study, with a sample of 101 patients diagnosed with cervical radiculopathy and who underwent an initial single-level ACDF or minimally invasive PCF during a 3-year period. Using these data, bivariate analyses were conducted to determine significant differences in direct total procedure and component costs between surgical techniques. Factorial ANOVAs were also conducted to determine any relationship between patient sex and smoking status to the component costs per surgery. Results The mean total direct cost for an ACDF was $8192, and the mean total direct cost for a PCF was $4320. There were significant differences in the cost components for direct costs and operating room supply costs. It was found that there was no statistically significant difference in component costs with regard to patient sex or smoking status. Conclusions In the management of single-level cervical radiculopathy, the present analysis has revealed that the average cost of an ACDF is 89% more than a PCF. This increased cost is largely due to the cost of surgical implants. These results do not appear to be dependent on patient sex or smoking status. When combined with results from previous studies highlighting the comparable patient outcomes for either procedure, the authors' findings suggest that from a health care economics standpoint, physicians should consider a minimally invasive PCF in the treatment of cervical radiculopathy.

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Microendoscopic posterior cervical foraminotomy: a cadaveric model and clinical application for cervical radiculopathy

Neurosurgical FOCUS ◽

10.3171/foc.1999.7.5.7 ◽

1999 ◽

Vol 7 (5) ◽

pp. E6

Author(s):

Timothy G. Burke ◽

Anthony Caputy

Keyword(s):

Cervical Radiculopathy ◽

Herniated Disc ◽

Surgical Approaches ◽

Foraminal Stenosis ◽

Posterior Cervical Foraminotomy ◽

The Mean ◽

Posterior Foraminotomy ◽

Cervical Foraminotomy ◽

Cadaveric Model ◽

Length Of Hospitalization

Cervical radiculopathy that is caused by either soft herniated disc material or foraminal stenosis is a common problem. Anterior and posterior surgical approaches are commonly performed to decompress the nerve root. The authors describe an endoscopic posterior foraminotomy procedure in which they use a rigid endoscope, in both a cadaveric model and in three clinical cases, including a multiple level case. Postoperatively, all patients returned to functional work status within 4 weeks. The mean length of hospitalization was 1.3 days. The advantages of this technique include improved visualization, a smaller incision, and significantly less postoperative discomfort when compared with a matched group of patients in whom open nonendoscopic foraminotomy has been performed.

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