JAAOS - 2026-08-26 - Journal Article
Anterior Cervical Diskectomy and Fusion versus Minimally Invasive Posterior Cervical Foraminotomy for the Treatment of Cervical Radiculopathy: A Meta-Analysis.
Boutros M, Awad G, Asmar C, Asmar R, Lovecchio FC
Topics
Key Takeaway
MIS-PCF versus ACDF for cervical radiculopathy yields equivalent functional outcomes (NDI, EQ-5D) and revision rates, but MIS-PCF reduces operative time by 14.72 minutes, hospital stay by 0.99 days, and cost by $9,131.93.
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Summary
This meta-analysis compared MIS-PCF and ACDF for cervical radiculopathy across 12 comparative studies (n=3,185) pooled from four databases through October 2025. MIS-PCF produced significantly shorter operative time (MD -14.72 min), shorter LOS (MD -0.99 days), lower cost (MD -$9,131.93), and superior neck pain reduction at both immediate and 1–2 year timepoints (MD -0.42 and -0.22, respectively), while arm pain relief, NDI, EQ-5D, revision rates, and overall complication rates were statistically equivalent between groups.
Key Limitation
The meta-analysis pools heterogeneous study designs without stratifying by pathology type (soft disc herniation vs. foraminal osteophyte), which confounds interpretation since MIS-PCF efficacy is highly lesion-dependent.
Original Abstract
BACKGROUND
Cervical radiculopathy can be managed surgically with anterior cervical diskectomy and fusion (ACDF) or minimally invasive posterior cervical foraminotomy (MIS-PCF). ACDF is widely used and provides indirect decompression and stabilization, while MIS-PCF preserves motion, avoids fusion-related complications, and may offer advantages in perioperative recovery. The aim of this meta-analysis was to compare surgical, patient-reported, and safety outcomes of MIS-PCF versus ACDF to guide clinical decision making.
METHODS
A systematic literature search of PubMed, Scopus, Cochrane Library, and Google Scholar was conducted through October 2025 to identify comparative studies of MIS-PCF and ACDF for cervical radiculopathy. Data from 12 studies involving 3,185 patients were pooled. Outcomes included surgical time, length of stay, hospital cost, pain scores (VAS arm and neck), functional scores (NDI and EQ-5D), revision surgery rates, and complication rates.
RESULTS
MIS-PCF was associated with significantly shorter surgical time (MD = -14.72 min, P < 0.001), reduced length of stay (MD = -0.99 days, P < 0.001), and lower hospital costs (MD = -$9,131.93, P < 0.001) compared with ACDF. Arm pain outcomes showed no significant differences between groups, either immediately postoperatively (P = 0.35) or at 1 to 2 years (P = 0.71). By contrast, MIS-PCF demonstrated significantly greater neck pain reduction immediately after surgery (MD = 0.42, P < 0.001) and at 1 to 2 years (MD = -0.22, P = 0.001). Functional outcomes (NDI and EQ-5D) were comparable between techniques (P ≥ 0.89). Revision surgery and overall complication rates did not differ significantly (P = 0.39 and P = 0.51, respectively).
CONCLUSION
Both MIS-PCF and ACDF are effective surgical options for cervical radiculopathy, with comparable reported safety and functional outcomes. MIS-PCF may offer perioperative advantages and better neck pain outcomes, supporting its role as a motion-preserving and cost-efficient alternative to ACDF in appropriately selected patients.