Foraminal Decompression Technique During ACDF for Cervical Radiculopathy that Provides a Better Outcome: Total Uncinatectomy vs Partial Uncoforaminotomy

Study DesignRetrospective cohort study.ObjectivesAnterior cervical discectomy and fusion (ACDF) provides clinical improvement for cervical radiculopathy. Recently, it was determined that foraminal decompression via uncinate process resection could lead to faster and greater improvement of arm pain. Total uncinatectomy (TU) and partial uncoforaminotomy (PU) are commonly used for direct foraminal decompression. But the advantages and pitfalls of the two techniques remain unknown.MethodsConsecutive patients(n = 306) who underwent single-level ACDF for degenerative cervical radiculopathy and who were followed up for >2 years were retrospectively reviewed.ResultsGroupTU had a significantly higher degree of subsidence than GroupPU. The 1-year and 2-year fusion rates were higher in GroupPU than those in GroupTU. Postoperative arm pain VAS score, neck pain VAS score, and NDI scores did not demonstrate significant intergroup differences at all time points. GroupTU had a significantly longer operative time, greater EBL, higher dysphagia rate, and more severe retropharyngeal soft tissue swelling than GroupPU did. There was one case (0.7%) of cerebral infarction due to vertebral artery injury in GroupTU.ConclusionPU resulted in lesser complications, shorter operative time, and lesser intraoperative bleeding than did TU. Moreover, the uncinate process was partially preserved in PU as a potential stabilizer, causing lesser subsidence and higher fusion rates. However, the clinical efficacy of PU was comparable to that of TU. Thus, resection of only the posterior part of the uncinate process provides sufficient direct foraminal decompression. Therefore, PU could be an effective and safer alternative to TU for foraminal decompression during ACDF.