Inpatient Level of Care for ACDF and Posterior Foraminotomy

Patient Assessment and Procedure

A 58-year-old patient with a 20-year history of neck pain and moderate to severe canal stenosis at multiple levels can undergo ACDF and posterior foraminotomy, with symptoms including radiating pain and weakness in grip, and has attempted conservative treatments with minimal relief 1
The patient's condition includes canal stenosis at C6-7, C5-6, C4-5 with multiple levels of neural foraminal stenosis, and reports radiating pain to the trapezius, shoulder blades, and proximal arms 1, 2

Anterior cervical discectomy and fusion (ACDF) is an established treatment for cervical radiculopathy with reported good to excellent outcomes in approximately 90% of patients, according to the American Association of Neurological Surgeons 3, 4
Posterior foraminotomy is also an effective treatment option for cervical radiculopathy with reported success rates ranging from 52-99%, as recommended by the Congress of Neurological Surgeons 2, 5

The Milliman Care Guidelines (MCG) recommend ambulatory care for cervical fusion procedures, including multilevel ACDF and posterior foraminotomy, in the absence of specific clinical factors necessitating inpatient admission 1
The MCG Musculoskeletal Surgery or Procedure guideline indicates ambulatory care as appropriate for this type of procedure, according to the American Medical Association 1