Posterior Cervical Foraminotomy Compared with Anterior Cervical Discectomy with Fusion for Cervical Radiculopathy: Two-Year Results of the FACET Randomized Noninferiority Study.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2025;13(14):31 J Bone Joint Surg Am. 2024 Jul 24;106(18):1653–1663.What this means for my practice?
Posterior cervical foraminotomy is a noninferior and reasonable surgical alternative to anterior cervical discectomy with fusion for single-level cervical radiculopathy, offering similar outcomes and complication rates. Clinicians should consider posterior surgery when counseling patients, especially due to its motion-preserving and implant-free nature. However, slightly higher rates of recurrent symptoms and reoperations may limit its use in some cases.
Study Summary
Two hundred sixty-five patients with single-level cervical radiculopathy were randomized to receive either posterior cervical foraminotomy (n=132) or anterior cervical discectomy with fusion (n=133). The primary outcomes were procedural success (based on Odom criteria) and reduction in arm pain (measured by VAS). Secondary outcomes included neck pain, Neck Disability Index, Work Ability Index, quality of life (EQ-5D-5L), treatment satisfaction, and complication rates, including reoperations. Outcomes were assessed at multiple time points up to 2 years. Overall, the results of the study revealed that posterior surgery was noninferior to anterior surgery for both primary outcomes, with similar secondary outcome profiles and adverse event rates. These findings suggest posterior cervical foraminotomy is a viable alternative to anterior surgery in suitable patients.
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