Introduction: Posterior foraminotomy (FOR) has been shown to be an effective surgical treatment for cervical radiculopathy. The efficacy and safety of FOR has been demonstrated in scattered series, although such studies suffer from limited sample sizes and short-term follow-up. Moreover, there is little data analyzing the relative effectiveness of FOR in the treatment of radiculopathy due to soft disc versus osteophyte disease. In the present study we review our experience with FOR for cervical radiculopathy in a large cohort of patients treated at one center with long-term follow-up.

Methods: We retrospectively examined the charts of patients who underwent a total 1085 FORs between 1990 and 2009. A large cohort of these patients also participated in a structured telephone interview designed to assess improvement in symptoms and function. A total 338 interviews were completed with a mean follow-up of 10 years.

Results: Interviewees reported a mean of approximately 90 percent improved pain, weakness, and function following FOR. Such symptomatic relief allowed 93 percent of patients to return to work after FOR. The overall complication rate of FOR was 3.3 percent and the rate of recurrent radiculopathy requiring surgery was 6.2 percent. Soft disc subtypes were compared to osteophyte disease by operative report and were associated with significantly improved pain, weakness and function. The operative report of these pathologic subtypes was significantly associated with the preoperative MRI interpretation (p<0.0001).

Conclusions: These results suggest that FOR is a highly effective surgical treatment for cervical radiculopathy with a low incidence of complications. Radiculopathy due to soft disc pathology may be associated with a better prognosis compared to osteophyte disease. These common etiologies for radiculopathy may be differentiated on preoperative MRI scans, providing an opportunity for surgeons to predict outcome.

Patient Care: This study addresses the efficacy of posterior foraminotomy for cervical radiculopathy and explores associations between patient characteristics and outcomes, which will aid surgeons in predicting outcomes.

Learning Objectives: 1. Based on data presented, posterior foraminotomy (FOR) is a highly effective and safe surgical treatment for cervical radiculopathy 2. These data indicate that patients undergoing FOR with soft disc disease may fare better than those with osteophytic disease 3. Weaknesses of this study include those inherent in a retrospective design, and randomized clinical trials may be needed to differentiate outcomes based on pathologic subtype and to compare FOR and ACD/F

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