Changes in Foraminal Geometry With Anterior Decompression Versus Keyhole Foraminotomy in the Cervical Spine: A Biomechanical Investigation

Cervical spondylosis can be treated with various surgical decompression techniques, notably anterior cervical decompression and fusion (ACDF) and posterior keyhole foraminotomy¹. Although each procedure has distinct methods, there is no compelling evidence in the literature to advocate one over the other. Furthermore, subtle differences within the techniques have yet to be examined such as the salvage or resection of uncovertebral joints during ACDF. Systematic reviews^2,5 and meta-analyses³ have not elucidated significant differences in pain improvement between ACDF techniques, and no study has compared clinical outcomes for ACDF versus posterior foraminotomy, the two most popular cervical decompression techniques to date. We provide benchtop evidence as to the relative effectiveness of foraminotomy, ACDF with or without resection, and a combination of all surgeries. We hypothesized that ACDF with uncovertebral resection would be most effective to open the neuroforamina. Results of this study inform best practices for cervical decompression surgeries.