Cervical Foraminotomy Andrew K. Simpson, MD Cervical Foraminotomy - PowerPoint PPT Presentation

Cervical Foraminotomy Andrew K. Simpson, MD

Cervical Foraminotomy The most cost-effective, evidence- based, motion preserving solution to cervical radiculopathy

Cervical Radiculopathy Treatments • ACDF • Disc Arthroplasty • Foraminotomy

ACDF • Tried-and-True • Most Forgiving – Technically • Cephalocaudal Foraminal Restoration – Diagnostically • Axial Symptoms – Facet Arhthropathy – Discogenic Symptoms • Instability • Kyphosis • Disadvantages – Reoperation Rates (~15% at 5 years) • Pseudo • ASD – Loss of Motion – Cost - Effectiveness

Disc Arthroplasty • Latest and Greatest • Motion Preserving – Patient ROM / Clinical benefit – Adjacent Segment Maintenance • Most common failure mechanism is delayed fusion • Only option that achieves ventral central and foraminal decompression and maintains motion • More Cost-Effective than ACDF • Disadvantages – Learning curve • Decompression • Implant positioning / Sizing • May be changes in complications with increased adoption… – Implant Failure

Cervical Foraminotomy • What’s Old is New • Motion Preserving without Implants – No Pseudo – No Adjacent Segment Disease – No implant failure – No rep / implant issues • Most Cost-Effective Treatment for Cervical Radiculopathy • Most common failure modality is incomplete decompression (Salvage ACDF) • Disadvantages – Posterior Approach (Pain / Muscle trauma) • Improved with less invasive techniques – Positioning – Reimbursement • Foraminotomy $1100 - $1500 • ACF $3000 - $3800

The Evidence Foraminotomy has lowest complication rate

The Evidence Foraminotomy index level reoperation same as ACDF at 2 years

The Evidence Foraminotomy same efficacy as ACDF but cheaper

The Evidence Foraminotomy half the cost of ACDF due to surgical implant cost.

Cervical Foraminotomy “A great way to spend an hour positioning a patient when I could have already finished an ACDF, got paid 3 times as much, and moved on to my next case.”

Foraminotomy

Foraminotomy

Less Disruptive Surgical Approaches

Ideal Foraminotomy Patients

Cervical Foraminotomy The most cost-effective, evidence- based, motion preserving solution to cervical radiculopathy