Surgery Versus Nonsurgical Treatment of Cervical Radiculopathy

Abstract

Study DesignProspective randomized controlled trial. ObjectiveTo study the outcome of anterior cervical decompression and fusion (ACDF) combined with a structured physiotherapy program compared to the same physiotherapy program alone for patients with cervical radiculopathy. Summary of Background DataKnowledge concerning the effects of interventions for patients with cervical radiculopathy is scarce due to a lack of randomized studies. Methods63 patients were randomized to surgery with postoperative physiotherapy (n=31) or physiotherapy alone (n=32). The surgical group was treated with ACDF. The physiotherapy program included general/specific exercises and pain coping strategies. The outcome measures were disability (Neck Disability Index, NDI), neck-and arm-pain intensity (VAS) and the patient's global assessment. Patients were followed for 24 months. ResultsThe result from the repeated-measures ANOVA showed no significant between group difference for NDI (p=0.23).For neck-pain intensity, the repeated-measures ANOVA showed a significant between group difference over the study period in favor of the surgical group (p=0.039).For arm-pain intensity, no significant between group differences was found according to the repeated-measures ANOVA (p=0.580).Radiculopathy, surgery vs non-surgical treatment 4 87% of the patients in the surgical group rated their symptoms as "better/much better" at the 12-month follow-up, compared to 62% in the non-surgical group (p<0.05). At 24 months the corresponding figures were 81% and 69% (p=0.28). The difference was significant only at the 12-month follow-up in favor of the surgical group.Significant reduction in NDI, neck-pain and arm-pain compared to baseline was seen in both groups (p<0.001). ConclusionsIn this prospective, randomized study of patients with cervical radiculopathy, it was shown that surgery with physiotherapy resulted in a more rapid improvement during the first postoperative year, with significantly greater improvement in neck pain and the patient's global assessment compared to physiotherapy alone, but the differences between the groups decreased after two years. Structured physiotherapy should be tried before surgery is chosen. Radiculopathy, surgery vs non-surgical treatment 5 Mini Abstract/ PrécisA prospective, randomized study comparing surgery plus physiotherapy with physiotherapy alone for patients with cervical radiculopathy was conducted. Surgery resulted in a more rapid improvement during the first postoperative year, with significantly greater improvement in neck pain and the patient's global assessment compared to physiotherapy alone, but the differences between the groups decreased after two years. Key PointsPatients with cervical radiculopathy were randomized to ACDF with physiotherapy or physiotherapy alone.Significant improvement was found with regard to disability, neck-and arm-pain intensity, and global assessment in both groups at the 1 and 2 year follow-ups.A significantly better result was seen after ACDF regarding neck pain and glo...

Retrospective Evaluation of Efficiency and Safety of an Anterior Percutaneous Approach for Cervical Discectomy

“…Neurological signs were greatly reduced after surgery-patients suffered from significantly less arm pain, pareses and paresthesias. This is in line with previously published reports that found the surgery effective for the treatment of cervical radiculopathy in terms of pain reduction, disability, weakness, and numbness [23,24,25,26]. Also, significantly lower neck pain was reported after the intervention.…”

“…However, when neck pain is associated with radiculo- or myelopathy, surgical intervention has been reported to alleviate the symptoms [25,26]. Engquist et al [26] recently published a randomized controlled trial comparing surgery plus physiotherapy to physiotherapy alone. The results suggested that the combined approach is superior to physiotherapy.…”

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“…However, some suffer from complications following surgery and require additional surgery due to severe pain. According to the latest research, surgery resulted in the same outcomes as those of physical therapy without surgery after two years in terms NDI and arm pain [10].…”

An Outcome Study of Anterior Cervical Discectomy and Fusion among Iranian Population

“…Outcome of surgical management for cervical disc herniation has shown a success rate of 66 to 98% [8]. ACDF has demonstrated good results in terms of pain relief and patient satisfaction [9]. Its success rate has been reported to achieve good or excellent outcome in 93% [10].…”