{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:30:32Z","timestamp":1792798232606,"version":"4.5.0"},"reference-count":36,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2010,5]]},"abstract":"<jats:sec>\n                    <jats:title>Object<\/jats:title>\n                    <jats:p>To review the cost effectiveness for the management of a unilateral cervical radiculopathy with either posterior cervical foraminotomy (PCF) or anterior cervical discectomy and fusion (ACDF) in military personnel, with a particular focus on time required to return to active-duty service.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Following internal review board approval, the authors conducted a retrospective review of 38 cases in which patients underwent surgical management of unilateral cervical radiculopathy. Nineteen patients who underwent PCF were matched for age, treatment level, and surgeon to 19 patients who had undergone ACDF. Successful outcome was determined by return to full, unrestricted active-duty military service. The difference in time of return to active duty was compared between the groups. In addition, a cost analysis consisting of direct and indirect costs was used to compare the PCF group to the ACDF group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 21 levels were operated on in each group. There were 17 men and 2 women in the PCF group, whereas all 19 patients in the ACDF group were men. The average age at the time of surgery was 41.5 years (range 27\u201356 years) and 39.3 years (range 24\u201352 years) for the PCF and ACDF groups, respectively. There was no statistically significant difference in operating room time, estimated blood loss, or postoperative narcotic refills. Complications included 2 cases of transient recurrent laryngeal nerve palsy in the ACDF group. The average time to return to unrestricted full duty was 4.8 weeks (range 1\u20138 weeks) in the PCF group and 19.6 weeks (range 12\u201332 weeks) in the ACDF group, a difference of 14.8 weeks (p &lt; 0.001). The direct costs of each surgery were $3570 for the PCF and $10,078 for the ACDF, a difference of $6508. Based on the 14.8-week difference in time to return to active duty, the indirect cost was calculated to range from $13,586 to $24,045 greater in the ACDF group. Total cost (indirect plus direct) ranged from $20,094 to $30,553 greater in the ACDF group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In the management of unilateral posterior cervical radiculopathy for military active-duty personnel, PCF offers a benefit relative to ACDF in immediate short-term direct and long-term indirect costs. The indirect cost of a service member away from full, unrestricted active duty 14.8 weeks longer in the ACDF group was the main contributor to this difference.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2010.1.focus09305","type":"journal-article","created":{"date-parts":[[2011,2,23]],"date-time":"2011-02-23T11:40:52Z","timestamp":1298461252000},"page":"E17","source":"Crossref","is-referenced-by-count":87,"title":["Management of unilateral cervical radiculopathy in the military: the cost effectiveness of posterior cervical foraminotomy compared with anterior cervical discectomy and fusion"],"prefix":"10.3171","volume":"28","author":[{"given":"Luis M.","family":"Tumial\u00e1n","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan P.","family":"Ponton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wayne M.","family":"Gluf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1 Suppl","key":"b1-0280017","series-title":"J Neurosurg","first-page":"126","article-title":"Microendoscopic posterior cervical foraminotomy: a cadaveric model and clinical application for cervical radiculopathy","volume":"93","author":"Burke","year":"2000"},{"key":"b2-0280017","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"343","DOI":"10.3171\/2009.1.SPINE08899","article-title":"Posterior cervical foraminotomy for the treatment of cervical radiculopathy","volume":"10","author":"Fehlings","year":"2009"},{"issue":"5 Suppl","key":"b3-0280017","series-title":"Neurosurgery","first-page":"S37","article-title":"Minimally invasive cervical microendoscopic foraminotomy: an initial clinical experience","volume":"51","author":"Fessler","year":"2002"},{"key":"b4-0280017","series-title":"Orthop Clin North Am","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1016\/j.ocl.2007.02.009","article-title":"Posterior minimally invasive approaches for the cervical spine","volume":"38","author":"Gala","year":"2007"},{"key":"b5-0280017","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1227\/00006123-198311000-00004","article-title":"Posterior-lateral foraminotomy as an exclusive operative technique for cervical radiculopathy: a review of 846 consecutively operated cases","volume":"13","author":"Henderson","year":"1983"},{"key":"b6-0280017","series-title":"Spine","doi-asserted-by":"publisher","first-page":"1026","DOI":"10.1097\/00007632-199015100-00009","article-title":"Surgical management of cervical soft disc herniation. A comparison between the anterior and posterior approach","volume":"15","author":"Herkowitz","year":"1990"},{"key":"b7-0280017","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1016\/j.spinee.2006.03.007","article-title":"Minimally invasive tubular access for posterior cervical foraminotomy with three-dimensional microscopic visualization and localization with anterior\/posterior imaging","volume":"7","author":"Hilton","year":"2007"},{"key":"b8-0280017","series-title":"J Spinal Disord Tech","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1097\/01.bsd.0000211254.98002.80","article-title":"Minimally invasive 2-level posterior cervical foraminotomy: preliminary clinical results","volume":"20","author":"Holly","year":"2007"},{"key":"b9-0280017","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"347","DOI":"10.3171\/2008.12.SPINE08576","article-title":"The posterior cervical foraminotomy in the treatment of cervical disc\/osteophyte disease: a single-surgeon experience with a minimum of 5 years' clinical and radiographic follow-up","volume":"10","author":"Jagannathan","year":"2009"},{"key":"b10-0280017","series-title":"Neurosurg Clin N Am","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1016\/j.nec.2006.06.002","article-title":"Endoscopic posterior cervical foraminotomy and discectomy","volume":"17","author":"O'Toole","year":"2006"},{"key":"b11-0280017","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1227\/01.NEU.0000175729.79119.1d","article-title":"National trends in surgical procedures for degenerative cervical spine disease: 1990\u20132000","volume":"57","author":"Patil","year":"2005"},{"key":"b12-0280017","series-title":"Spine","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1097\/00007632-200001150-00019","article-title":"Endoscopic foraminotomy using MED system in cadaveric specimens","volume":"25","author":"Roh","year":"2000"},{"key":"b13-0280017","series-title":"Spine","doi-asserted-by":"publisher","first-page":"940","DOI":"10.1097\/BRS.0b013e31816c8b67","article-title":"Full-endoscopic cervical posterior foraminotomy for the operation of lateral disc herniations using 5.9-mm endoscopes: a prospective, randomized, controlled study","volume":"33","author":"Ruetten","year":"2008"},{"issue":"1 Supp1 1","key":"b14-0280017","series-title":"Neurosurgery","first-page":"S160","article-title":"Minimally invasive surgery for the management of cervical spondylosis","volume":"60","author":"Santiago","year":"2007"},{"key":"b15-0280017","series-title":"Spine","doi-asserted-by":"publisher","first-page":"955","DOI":"10.1097\/BRS.0b013e31819e2fd5","article-title":"Trends and variations in cervical spine surgery in the United States: medicare beneficiaries, 1992 to 2005","volume":"34","author":"Wang","year":"2009"},{"key":"b16-0280017","series-title":"Surg Neurol","first-page":"340","article-title":"Cervical discectomy. 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