A meta-analysis of cervical foraminotomy: open versus minimally-invasive techniques

Background contextThe posterior cervical foraminotomy (PCF) may be performed using an open or minimally-invasive (MIS) approach using a tubular retractor. Although there are theoretical advantages such as less blood loss and shorter hospitalizations, there is no consensus in the literature regarding the best approach for treatment.PurposeTo assess clinical outcomes of PCF treated with either an open or an MIS approach using a tubular retractor.Study designSystematic literature review and meta-analysis of English language studies for the treatment of cervical radiculopathy treated with foraminotomy.Patient samplePooled patient results from Level I studies and Level IV retrospective studies.Outcome measuresMeta-analysis for clinical success as determined by Odom and Prolo criteria, and visual analog scale scores for arm and neck pain.MethodsA literature search of three databases was performed to identify investigations performed in the treatment of PCF with an open or MIS approach. The pooled results were performed by calculating the effect size based on the logit event rate. Studies were weighted by the inverse of the variance, which included both within and between-study errors. Confidence intervals (CIs) were reported at 95%. Heterogeneity was assessed using the Q statistic and I-squared, where I-squared is the estimate of the percentage of error due to between-study variation.ResultsThe initial literature search resulted in 195 articles, of which, 20 were determined as relevant on abstract review. An open foraminotomy approach was performed in six; similarly, an MIS approach was performed in three studies. The pooled clinical success rate was 92.7% (CI: 88.9, 95.3) for open foraminotomy and 94.9% (CI: 90.5, 97.4) for MIS foraminotomy, which was not statistically significant (p=.418). The open group demonstrated relative homogeneity with Q value of 7.6 and I2 value of 34.3%; similarly, the MIS group demonstrated moderate study heterogeneity with Q value of 4.44 and I2 value of 54.94%.ConclusionsPatients with symptomatic cervical radiculopathy from foraminal stenosis can be effectively managed with either a traditional open or an MIS foraminotomy. There is no significant difference in the pooled outcomes between the two groups.