The impact of foraminotomy on patient-reported outcomes following 3+ level posterior cervical decompression and fusion for myeloradiculopathy

Objective: To evaluate whether patients with myeloradiculopathy experience better improvement in patient-reported outcome measures (PROMs) from the addition of foraminotomy in the setting of posterior cervical decompression and fusion (PCDF). Methods: Adult patients who underwent ≥≥ 3-level PCDF (2017–2022) at a single tertiary center were retrospectively identified. Patients were included if their indication was myeloradiculopathy – patients were excluded if they had a combined anterior/posterior approach, an indication of infection/tumor/trauma, or incomplete 1-year PROMs. Operative notes were evaluated to identify the patients who had a foraminotomy specifically for neuro-decompression. Patients with or without foraminotomy were evaluated for demographic/surgical variables, surgical outcomes, and PROMs. Appropriate statistics were performed, alpha was set at 0.05. Results: One hundred and seven PCDF patients were identified (33.6% foraminotomy and 66.4% nonforaminotomy). The two groups were similar regarding demographics and surgical metrics including cut-to-close and OR time and estimated blood loss. The two groups were similar in readmission rate at 30- and 90-days postoperatively, 1-year reoperation, and discharge disposition. Modified Japanese orthopedic association, short form-12 physical component score and mental component score, neck disability index, and visual analog scale (VAS) neck scores were similar between groups at all time points. The foraminotomy group had worse baseline VAS arm scores (5.56 ± 2.63 vs. 4.00 ± 2.69, P = 0.015) as well as greater improvement in VAS arm scores (−2.99 ± 3.22 vs. −1.25 ± 3.06, P = 0.035) at 1 year. Conclusion: Patients who had a foraminotomy experienced greater improvement in arm pain at 1-year follow-up without an increase in surgical time, hospital stay, or complications. The present study suggests that, for the appropriately selected patient undergoing PCDF for myeloradiculopathy, performing intentional foraminal decompression leads to improved outcomes at 1 year without altering surgical morbidity.