Cervical Spine Controversies; Nancy Epstein; ACDF Vs Posterior Surgery; Outcomes; complications; costs;

SUMMARY: Dr. Epstein reviews the literature on the efficacy of anterior vs posterior approaches to the lateral lesion in the cervical spine and concludes that the evidence for the Cervical Laminoforaminotomy is superior to that of the anterior approaches (ACD/ ACDF) for lesions in this region. posterior procedure. This is an excellent review and analysis of this management choice which reveals the problems with the ACDF approaches as inferior to the CLF. It is understood that a large number of physicians were not trained in this procedure, which is simpler and safer than the ACD/ACDF approach. Yet the CLF is simpler, less costly, and associated with less complications although physicians and hospitals are reimbursed less for CLF over ACD/ACDF. The potential complications are more serious with the ACD/ACDF. So this also becomes a healthcare economics issue. While everyone (physicians, Biomedical companies, Hospitals) are gaming the system to make money; the patient loses. What is the standard of care? How can it be changed for everyone's benefit? (ed- James Ausman)