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Cervical Foraminotomy Andrew K. Simpson, MD Cervical Foraminotomy - - PowerPoint PPT Presentation
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
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Cervical Radiculopathy Treatments
- ACDF
- Disc Arthroplasty
- Foraminotomy
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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
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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
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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
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The Evidence
Foraminotomy has lowest complication rate
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The Evidence
Foraminotomy index level reoperation same as ACDF at 2 years
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The Evidence
Foraminotomy same efficacy as ACDF but cheaper
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The Evidence
Foraminotomy half the cost of ACDF due to surgical implant cost.
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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.”
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Foraminotomy
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Foraminotomy
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Less Disruptive Surgical Approaches
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Ideal Foraminotomy Patients
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