Background: 

Short-term neck pain after posterior cervical foraminotomy (posterior surgery) compared with anterior cervical discectomy with fusion (anterior surgery) treating cervical radiculopathy has only been assessed once, retrospectively, to our knowledge. The aim of this study was to prospectively evaluate the course of neck pain for 6 weeks after both treatments.

Methods: 

This is a secondary analysis of the multicenter Foraminotomy ACDF Cost-Effectiveness Trial (FACET), conducted from January 2016 to May 2020. Of 389 patients who had single-level, 1-sided cervical radiculopathy and were screened for eligibility, 265 were randomly assigned to undergo posterior surgery (n = 132) or anterior surgery (n = 133). The primary outcome of the present analysis was neck pain, assessed weekly for 6 weeks using the visual analog scale (VAS), on a scale of 0 to 100. The secondary outcomes were arm pain, neck disability, work ability, quality of life, treatment satisfaction, motor and sensory changes, and hospital length of stay. Data were analyzed with mixed model analysis in intention-to-treat samples using 2-sided 95% confidence intervals (CIs).

Results: 

In the first postoperative week, the mean VAS for neck pain was 56.2 mm (95% CI, 51.7 to 60.8 mm) after posterior surgery and 46.7 mm (95% CI, 42.2 to 51.2 mm) after anterior surgery. The mean between-group difference was 9.5 mm (95% CI, 3.3 to 15.7 mm), which gradually decreased to 2.3 mm (95% CI, −3.6 to 8.1 mm) at postoperative week 6. As of postoperative week 5, there was no significant difference between groups. Responder analyses confirmed this result. Secondary outcomes showed small differences between groups.

Conclusions: 

Insight into the course of neck pain during the first 6 weeks after posterior compared with anterior surgery is provided. Despite initially more neck pain after posterior surgery, patients swiftly improved and, as of postoperative week 5, results similar to those after anterior surgery were observed. Our findings should enable improved patient counseling and enhanced shared decision-making between physicians and patients with cervical radiculopathy, where more neck pain in the first postoperative weeks should be balanced against the benefits of posterior surgery.

Level of Evidence: 

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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后路椎间孔切开术后短期颈部疼痛与前路椎间孔切除术融合治疗颈椎间孔神经根病的比较：FACET 随机对照试验的二次分析

背景： 

据我们所知，后路颈椎间孔切开术（后路手术）与前路颈椎间盘切除融合术（前路手术）治疗颈神经根病后的短期颈部疼痛仅进行了一次回顾性评估。本研究的目的是前瞻性评估两种治疗后 6 周内颈部疼痛的病程。

方法： 

这是对 2016 年 1 月至 2020 年 5 月进行的多中心椎间孔切开术 ACDF 成本效益试验 (FACET) 的二次分析。在 389 名患有单节段、一侧神经根型颈椎病并接受资格筛选的患者中，265 名被随机分配接受后路手术 (n = 132) 或前路手术 (n = 133)。本分析的主要结果是颈部疼痛，使用视觉模拟量表 (VAS) 每周评估一次，持续 6 周，评分范围为 0 到 100。次要结果是手臂疼痛、颈部残疾、工作能力、生活质量、治疗满意度、运动和感觉变化以及住院时间。使用双侧 95% 置信区间 (CI) 对意向治疗样本中的数据进行混合模型分析。

结果： 

术后第一周，后路手术后颈部疼痛的平均 VAS 为 56.2 毫米（95% CI，51.7 至 60.8 毫米），前路手术后为 46.7 毫米（95% CI，42.2 至 51.2 毫米）。平均组间差异为 9.5 毫米（95% CI，3.3 至 15.7 毫米），在术后第 6 周逐渐下降至 2.3 毫米（95% CI，-3.6 至 8.1 毫米）。截至术后第 5 周，有组间无显着差异。应答者分析证实了这一结果。次要结果显示组间差异很小。

结论： 

与前路手术相比，提供了对后路手术后前 6 周颈部疼痛过程的深入了解。尽管后路手术后最初颈部疼痛更严重，但患者会迅速好转，并且截至术后第 5 周，观察到的结果与前路手术后的结果相似。我们的研究结果应该能够改善患者咨询并加强医生和神经根型颈椎病患者之间的共同决策，术后第一周更多的颈部疼痛应该与后路手术的好处相平衡。

证据等级： 

治疗一级。有关证据等级的完整描述，请参阅作者须知。