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Randomized Controlled Trial
. 2014 Nov 9;15:437.
doi: 10.1186/1745-6215-15-437.

Comparison of Posterior Foraminotomy and Anterior Foraminotomy With Fusion for Treating Spondylotic Foraminal Stenosis of the Cervical Spine: Study Protocol for a Randomized Controlled Trial (ForaC)

Free PMC article
Randomized Controlled Trial

Comparison of Posterior Foraminotomy and Anterior Foraminotomy With Fusion for Treating Spondylotic Foraminal Stenosis of the Cervical Spine: Study Protocol for a Randomized Controlled Trial (ForaC)

Anja Tschugg et al. Trials. .
Free PMC article


Background: Cervical radiculopathy caused by spondylotic foraminal stenosis may require surgical treatment. Surgical options include anterior cervical foraminotomy and fusion or posterior cervical foraminotomy. Controversy remains regarding the preferable surgical approach. Pertinent clinical evidence is limited to low-quality observational reports. Therefore, treatment decisions are predominantly based on the individual surgeon's preference and skill. The study objective is to evaluate the efficacy and safety of posterior foraminotomy in comparison to anterior foraminotomy with fusion for the treatment of spondylotic foraminal stenosis.

Methods/design: This is a multicenter randomized, controlled, parallel group superiority trial. A total of 88 adult patients are allocated in a ratio of 1:1. Sample size and power calculations were performed to detect the minimal clinically important difference of 14 points, with an expected standard deviation of 20 in the primary outcome parameter, Neck Disability Index, with a power of 80%, based on an assumed maximal dropout rate of 20%. Secondary outcome parameters include the Core Outcome Measures Index, which investigates pain, back-specific function, work disability, social disability and patient satisfaction. Changes in physical and mental health are evaluated using the Short Form-12 (SF-12) questionnaire. Moreover, radiological and health economic outcomes are evaluated. Follow-up is performed 3, 6, 12, 24, 36, 48 and 60 months after surgery. Major inclusion criteria are cervical spondylotic foraminal stenosis causing radiculopathy of C5, C6 or C7 and requiring decompression of one or two neuroforaminae. Study data generation (study sites) and data storage, processing and statistical analysis (Department of Medical Statistics, Informatics and Health Economics) are clearly separated. Data will be analyzed according to the intention-to-treat principle.

Discussion: The results of the ForaC study will provide surgical treatment recommendations for spondylotic foraminal stenosis and will contribute to the understanding of its short- and long-term clinical and radiological postoperative course. This will hopefully translate into improvements in surgical treatment and thus, clinical practice for spondylotic foraminal stenosis.

Trial registration: Current Controlled Trials: ISRCTN82578069.


Figure 1
Figure 1
Data management and randomization process. Study data generation at the study sites is clearly separated from data storage, processing and statistical analysis.

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    1. McGuire KJ, Harrast J, Herkowitz H, Weinstein JN. Geographic variation in the surgical treatment of degenerative cervical disc disease: American board of orthopedic surgery quality improvement initiative; Part II candidates. Spine (Phila Pa 1976) 2012;37:57–66. doi: 10.1097/BRS.0b013e318212bb61. - DOI - PMC - PubMed
    1. Houser OW, Onofrio BM, Miller GM, Folger WN, Smith PL, Kallman DA. Cervical neural foraminal canal stenosis: computerized tomographic myelography diagnosis. J Neurosurg. 1993;79:84–88. doi: 10.3171/jns.1993.79.1.0084. - DOI - PubMed
    1. Spurling R. Lateral rupture of the cervical intervertebral discs: a common cause of shoulder and arm pain. Surg Gynecol Obstet. 1944;78:350–358.
    1. Frykholm R. Deformities of dural pouches and strictures of dural sheaths in the cervical region producing nerve-root compression; a contribution to the etiology and operative treatment of brachial neuralgia. J Neurosurg. 1947;4:403–413. doi: 10.3171/jns.1947.4.5.0403. - DOI - PubMed
    1. Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am. 1958;40-A:607–624. - PubMed

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