A randomised controlled trial comparing the effectiveness of surgical and nonsurgical treatment for cervical radiculopathy

Taso, Mirad; Sommernes, Jon Håvard; Kolstad, Frode; Sundseth, Jarle; Bjorland, Siri; Pripp, Are Hugo; Zwart, John Anker; Brox, Jens Ivar

doi:10.1186/s12891-020-3188-6

Cited by 24 publications

(16 citation statements)

References 49 publications

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“…Cervical radiculopathy is usually caused by cervical disc herniation, spondylosis or a combination of herniation and spondylosis which may trigger local ischaemia and inflammation [ 14 ]. Recent studies have demonstrated a favourable natural course of CSR within the first 4–6 months with complete recovery ranging from 24 to 36 months in approximately 83% of patients [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

An open-label non-inferiority randomized trail comparing the effectiveness and safety of ultrasound-guided selective cervical nerve root block and fluoroscopy-guided cervical transforaminal epidural block for cervical radiculopathy

Cui¹,

Zhang²,

Zhao

et al. 2022

Annals of Medicine

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Object To compare therapeutic efficacy and safety of ultrasound (US)-guided selective nerve root block (SNRB) and fluoroscopy (FL)-guided transforaminal epidural steroid injection (TFESI) for cervical spine radiculopathy (CSR). Method 156 patients with CSR randomly received US-guided SNRB verified by FL or FL-guided TFESI. We hypothesised that the accuracy rate of contrast dispersion into epidural or intervertebral foraminal space in the US group was not inferior to that in the FL group with a margin of clinical unimportance of −15%. Pain intensity assessed by Numeric Rating Scales (NRS) and functional disability estimated by neck disability index (NDI) were compared before treatment, at 1, 3 and 6 months after the intervention. Puncture time and complication frequencies were also reported. Results 88.7% and 90.3% accuracy ratings were respectively achieved in the US and FL groups with a treatment difference of −1.6% (95%CI: −9.7%, 6.6%) revealing that the lower limit was above the non-inferiority margin. Both NRS and NDI scores illustrated improvements at 1, 3 and 6 months after intervention with no statistically significant differences between the two groups (all p > .05). Additionally, shorter administration duration was observed in the US group ( p < .001). No severe complications were observed in both group. Conclusion Compared with the FL group, the US group provided a non-inferior accuracy rate of epidural/foraminal contrast pattern. For the treatment of CSR, the US technique provided similar pain relief and functional improvements while facilitating distinguishing critical vessels adjacent to the foramen and requiring a shorter procedure duration without exposure to radiation. Therefore, it was an attractive alternative to the conventional FL method. Key messages We conducted a prospective, open-label, randomised and non-inferiority clinical trial to estimate a hypothesis that the precisely accurate delivery through ultrasound (US)-guided cervical selective nerve root block (SNRB) was non-inferior to that using FL-guided transforaminal epidural steroid injection. Additionally, US-guided SNRB was as effective as FL-guided TFESI in the treatment effect on pain relief and function improvements. Notably, the US technique might be an alternative to the conventional FL method due to the ability to prevent inadvertent vascular puncture (VP) and intravascular injection (IVI) with a shorter administration time and absence of radiation exposure.

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Section: Discussionmentioning

confidence: 99%

An open-label non-inferiority randomized trail comparing the effectiveness and safety of ultrasound-guided selective cervical nerve root block and fluoroscopy-guided cervical transforaminal epidural block for cervical radiculopathy

Cui¹,

Zhang²,

Zhao

et al. 2022

Annals of Medicine

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“…Chronic degeneration of the cervical spine is the basic cause of the occurrence and development of CSR. The main symptoms of CSR are neck pain, arm numbness, and limited neck movement, and some patients with CSR develop depression and insomnia, which seriously decrease quality of life [ 2 ]. For CSR that does not respond to conservative treatment, anterior cervical decompression and fusion (ACDF) is a routine and effective method that is considered the “gold standard” [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of ACDF combined with different degrees of partial resection of uncovertebral joints on cervical stability and degeneration: a three-dimensional finite element analysis

2022

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Background To evaluate the influence of the resection of different amounts of the uncovertebral joints on the stability of the cervical spine by comparing and analyzing the stress distribution and peak displacement characteristics of the internal fixation structures and endplates. Methods After obtaining the CT data of a 34-year-old male healthy cervical spine, a three-dimensional finite element model was established and verified. The three-dimensional finite element method was used to establish the models of anterior cervical compression fusion and internal fixation surgical implants and anterior cervical compression fusion and internal fixation combined with the partial resection of different amounts of the unilateral or bilateral uncovertebral joints. The models were tested under six working conditions: flexion, extension, left bending, right bending, left rotation, and right rotation. The surgical models were compared regarding the stress distribution of the titanium mesh, titanium plate and screw, and endplate, and the peak displacement of the vertebral body. Results There were no significant differences in the stress distribution and peak displacement of the vertebral body of ACDF combined with different amounts of uncovertebral joint resection in the states of flexion and extension. However, there were significant increases in the stress distribution and peak displacement of the vertebral body in the states of left and right bending and rotation. In the states of left and right bending and rotation, the stress distribution and peak displacement of the vertebral body were significantly greater in the models with bilateral partial resection of the uncovertebral joints than in the models with unilateral partial resection of the uncovertebral joints. Bilateral resection of the uncovertebral joints by 30–40% and unilateral resection of the uncovertebral joints by 40–50% resulted in the greatest increases in the maximum stress distribution of the titanium plate and screw and the peak displacement of the vertebral body. Conclusion Finite element analysis of the biomechanical changes in the cervical spine showed that anterior cervical compression fusion and internal fixation combined with bilateral resection of less than 30% of the uncovertebral joints or unilateral resection of less than 40% of the uncovertebral joints had little effect on the stability of the cervical spine.

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“…At present, there are many nondrug conservative treatment methods, such as acupuncture, massage, herbal compresses, low frequency therapy, and microwaves, all of which are effective. Numerous studies have shown that the clinical efficacy of conservative treatment and surgical treatment is the identical [3] . Therefore, it is important to investigate how best combined conservative treatment can be used to improve neck pain and nerve root symptoms in patients with radiculopathy and to alleviate the progression of cervical spondylosis.…”

Section: Introductionmentioning

confidence: 99%

Clinical observation of Long chiropractic treatment on patients with neurogenic cervical spondylosis

Wang

et al. 2022

Medicine

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Neurogenic cervical spondylosis is the most common type of cervical spondylosis, accounting for approximately 60% percent of the incidence of cervical spondylosis. Cervical spine Long manipulation and sling exercise training (SET) have obtained good therapeutic results in clinical rehabilitation. The aim of this study was to evaluate the effect of Long manipulation combined with SET on neurogenic cervical spondylosis. In this assessor-blind, randomized controlled trial, 90 eligible patients will be randomized into a combination treatment group (Long manipulation combined with SET), a Long manipulation group and a conventional massage group. The visual analogue score, the Neck Disability Index score, and muscle fatigue in the bilateral upper oblique and Musculus sternocleidomastoideus, using mean power frequency and median frequency from the surface electromyography frequency domain index, will be assessed before and after the intervention at 0 and 4 weeks, respectively.Trial registration: Registered in the Chinese Clinical Trial Registration Center with the number ChiCTR2100054978. Registered

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A randomised controlled trial comparing the effectiveness of surgical and nonsurgical treatment for cervical radiculopathy

Cited by 24 publications

References 49 publications

An open-label non-inferiority randomized trail comparing the effectiveness and safety of ultrasound-guided selective cervical nerve root block and fluoroscopy-guided cervical transforaminal epidural block for cervical radiculopathy

An open-label non-inferiority randomized trail comparing the effectiveness and safety of ultrasound-guided selective cervical nerve root block and fluoroscopy-guided cervical transforaminal epidural block for cervical radiculopathy

Effect of ACDF combined with different degrees of partial resection of uncovertebral joints on cervical stability and degeneration: a three-dimensional finite element analysis

Clinical observation of Long chiropractic treatment on patients with neurogenic cervical spondylosis

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