Introduction: TDA has gained popularity as a surgical treatment for cervical radiculopathy or myelopathy. Currently, TDA is approved for a single level procedure; juxtaposed level disease(JLD) requires either a simple anterior diskectomy (ACD) or ACD with fusion (ACDF) be performed. Persistent radicular pain (PRP) following an anterior cervical foraminotomy may occur in ~ 9% of cases necessitating further surgery, e.g., posterior foraminotomy.(ref.1) A series of cases was reviewed to assess PRP following TDA. The feature(s) that may be relevant to PRP were explored.

Methods: A series of 40 consecutive cases undergoing TDA, with and without a second level of surgery, was reviewed. PRP was defined as a radicular pain recalcitrant to palliative management and requiring secondary surgical management. The prevalence of PRP following TDA was determined and relevance of the demographic features of sex, level of TDA, and JLD surgery assessed.

Results: Forty patients underwent TDA: 24 males; 16 females at C3 level(5); C4(6); C5(26); C6(7); a total of 44 TDAs(4 cases had a 2nd-level procedure at a non-juxtaposed level). Twelve underwent an ACD(2) or ACDF(11) for JLD(1 with two juxtaposed levels). A secondary procedure for PRP was required in 2(both female; both C5 level TDA) of these 12 cases (13 levels) A residual osteophyte at the level of the TDA(Case 2) and foraminal compression at the JLD undergoing ACDF(Case 1) were the structural pathology identified in these cases. Foraminotomy successfully relieved the PRP. None of the 28 patients without a JLD procedure required reoperation for PRP. {r x c Exact Contingency Table p=0.095[JLD]; p=0.154[sex]; p=1.00[level of TDA]}.(ref.2)

Conclusions: The prevalence of PRP following TDA was 5% in this series; and was more likely to occur in the context of surgery also being performed at the JLD to the TDA (~ 15%). Patient gender and the level of TDA were not relevant to PRP.

Patient Care: Highlighting the feature responsible for PRP following TDA, i.e, JLD surgery, and suggesting better attention be given to foraminal osteophytectomy and decompression at the time of TDA, should mitigate the prevalence of this problem postoperatively.

Learning Objectives: To identify the prevalence of persistent radicular pain following total disk arthroplasty, and the factor(s) involved.

References: 1. Anterior cervical foraminotomy for unilateral radicular disease. J P Johnson, A G Filler, D Q McBride, U Batzdorf Spine. 2000 Apr 15;25 (8):905-9 2. r x c Exact Contingency Table http://www.physics.csbsju.edu/cgi-bin/stats/exact