Comparison of biomechanical response to surgical procedures used for cervical radiculopathy: posterior keyhole foraminotomy versus anterior foraminotomy and discectomy versus anterior discectomy with fusion.

The objective of this study was to compare the change in flexibility of C5-C6 caused by three procedures using a three-dimensional nonlinear finite element model: posterior foraminotomy (keyhole procedure), anterior foraminotomy with discectomy, and anterior discectomy with fusion. The keyhole procedure produced a minor increase in motion. The anterior foraminotomy and discectomy produced one to two times greater motion. Anterior discectomy with fusion produced 50% to 100% reduction in motion. The posterior keyhole foraminotomy has a much lesser effect on the stability of the cervical spine segment than does an anterior procedure, and fusion is a requisite part of the anterior decompression procedure.