Anterior Cervical Discectomy and Fusion (ACDF) Compared With Transforaminal Epidural Corticosteroid Injection (TFESI) for Cervical Radiculopathy

Study Design: Prospective multicentre cohort study. Objective: This study aimed to compare the holistic improvement of patients with cervical radiculopathy in all health domains (pain, disability, and QOL) following ACDF and TFESI in patients with cervical radiculopathy, identifying patient subgroups that may benefit more from one or both treatments. Summary of Background Data: Cervical radiculopathy, characterized by neck and arm pain, significantly affects quality of life (QOL) and functional capacity. While anterior cervical discectomy and fusion (ACDF) is a common surgical intervention for persistent symptoms, transforaminal epidural corticosteroid injection (TFESI) offers a less invasive alternative. Limited data exists comparing their effectiveness on disability and QOL. Methods: This pragmatic multicenter cohort study included patients diagnosed with cervical radiculopathy at 3 Belgian hospitals. Patients received either ACDF (n=34) or TFESI (n=57) based on clinical assessment and patient choice. Pain, disability, and QOL were assessed over an 8-month follow-up using the visual analog scale (VAS), Neck Disability Index (NDI), and EQ-5D, respectively. A hierarchical cluster analysis categorized patients into subgroups for targeted analysis. Results: At 8 months, both treatments improved pain scores (VAS), but ACDF showed significantly greater improvements in NDI ( P <0.001) and EQ-5D ( P <0.001) compared with TFESI. Cluster analysis revealed that patients with high baseline disability (cluster 3) benefited most from ACDF in terms of both QOL and functional recovery. The probability of a reduction in pain medication use is greater after ACDF. Conclusion: ACDF provides superior improvement in disability and QOL for patients with severe cervical radiculopathy compared with TFESI, particularly for patients with severe pretreatment health status (cluster 3). Personalized treatment strategies, guided by patient profiles such as those revealed in this study, may lead to optimized outcomes.