Anterior Cervical Discectomy and Fusion Versus Posterior Cervical Foraminotomy for Cervical Radiculopathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

STUDY DESIGN: Meta-analysis of randomized controlled trials. OBJECTIVES: To compare the efficacy and safety of ACDF versus PCF for the treatment of cervical radiculopathy. SUMMARY OF BACKGROUND DATA: ACDF is widely regarded as the standard surgical treatment for cervical radiculopathy, providing reliable symptom relief but carrying risks such as adjacent segment disease, pseudoarthrosis, and implant-related complications. PCF represents a motion-preserving alternative that avoids anterior approach-related morbidity. Despite existing comparative studies, the optimal surgical approach remains controversial. METHODS: A systematic review and meta-analysis were conducted according to PRISMA guidelines. PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched to identify randomized controlled trials comparing ACDF and PCF for cervical radiculopathy. The primary outcome was clinical efficacy assessed using the Odom criteria. Secondary outcomes included perioperative complications, revision surgery, and treatment satisfaction. Pooled analyses were performed using random-effects models, and heterogeneity was assessed with the I2 statistic. RESULTS: Five randomized controlled trials involving 568 patients were included, with 284 patients (50%) undergoing ACDF. Mean follow-up ranged from 12 to 50.4 months. There was no significant difference between ACDF and PCF in the proportion of patients achieving excellent or good outcomes according to the Odom criteria (OR: 1.18; 95% CI: 0.48-2.87; P=0.72). Perioperative complication rates (OR: 0.43; 95% CI: 0.10-1.76; P=0.24), revision surgery rates (OR: 1.39; 95% CI: 0.66-2.94; P=0.39), and treatment satisfaction (OR: 0.88; 95% CI: 0.54-1.37; P=0.62) were also comparable between groups. CONCLUSION: This meta-analysis of randomized controlled trials demonstrates no significant differences between ACDF and PCF in terms of clinical efficacy, safety, revision surgery, or patient satisfaction for cervical radiculopathy. Given its motion-preserving nature and avoidance of anterior approach-related complications, PCF remains a valid surgical alternative in selected patients.