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Meta-Analysis
. 2010 Jan 20;2010(1):CD001466.
doi: 10.1002/14651858.CD001466.pub3.

Surgery for cervical radiculopathy or myelopathy

Ioannis Nikolaidis  1 , Ioannis P Fouyas, Peter Ag Sandercock, Patrick F Statham
Affiliations
Meta-Analysis

Surgery for cervical radiculopathy or myelopathy

Ioannis Nikolaidis et al. Cochrane Database Syst Rev. .

Abstract

Background: Cervical spondylosis causes pain and disability by compressing the spinal cord or roots. Surgery to relieve the compression may reduce the pain and disability, but is associated with a small but definite risk. .

Objectives: To determine whether: 1) surgical treatment of cervical radiculopathy or myelopathy is associated with improved outcome, compared with conservative management and 2) timing of surgery (immediate or delayed pending persistence/progression of relevant symptoms and signs) has an impact on outcome.

Search strategy: We searched CENTRAL, MEDLINE, and EMBASE to 1998 for the original review. A revised search was run in CENTRAL (The Cochrane Library 2008, Issue 2), MEDLINE, EMBASE, and CINAHL (January 1998 to June 2008) to update the review.Authors of the identified randomised controlled trials were contacted for additional published or unpublished data.

Selection criteria: All randomised or quasi-randomised controlled trials allocating patients with cervical radiculopathy or myelopathy to 1) "medical management" or "decompressive surgery (with or without fusion) plus medical management" 2) "early decompressive surgery" or "delayed decompressive surgery".

Data collection and analysis: Two authors independently selected trials, assessed risk of bias and extracted data.

Main results: Two trials (N = 149) were included. In both trials, allocation concealment was inadequate and arrangements for blinding of outcome assessment were unclear.One trial (81 patients with cervical radiculopathy) found that surgical decompression was superior to physiotherapy or cervical collar immobilization in the short-term for pain, weakness or sensory loss; at one year, there were no significant differences between groups.One trial (68 patients with mild functional deficit associated with cervical myelopathy) found no significant differences between surgery and conservative treatment in three years following treatment. A substantial proportion of cases were lost to follow-up.

Authors' conclusions: Both small trials had significant risks of bias and do not provide reliable evidence on the effects of surgery for cervical spondylotic radiculopathy or myelopathy. It is unclear whether the short-term risks of surgery are offset by long-term benefits. Further research is very likely to have an impact on the estimate of effect and our confidence in it.There is low quality evidence that surgery may provide pain relief faster than physiotherapy or hard collar immobilization in patients with cervical radiculopathy; but there is little or no difference in the long-term.There is very low quality evidence that patients with mild myelopathy feel subjectively better shortly after surgery, but there is little or no difference in the long-term.

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Conflict of interest statement

None Known

Figures

1
1
Risk of bias assessment: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Surgery vs physiotherapy in cervical radiculopathy, Outcome 1 Radicular pain (current‐VAS) at presentation.
1.2
1.2. Analysis
Comparison 1 Surgery vs physiotherapy in cervical radiculopathy, Outcome 2 Radicular pain (current‐VAS) at 3 months following treatment.
1.3
1.3. Analysis
Comparison 1 Surgery vs physiotherapy in cervical radiculopathy, Outcome 3 Radicular pain (current‐VAS) at 1 year following treatment.
1.4
1.4. Analysis
Comparison 1 Surgery vs physiotherapy in cervical radiculopathy, Outcome 4 Radicular pain (worst‐VAS) at presentation.
1.5
1.5. Analysis
Comparison 1 Surgery vs physiotherapy in cervical radiculopathy, Outcome 5 Radicular pain (worst‐VAS) at 3 months following treatment.
1.6
1.6. Analysis
Comparison 1 Surgery vs physiotherapy in cervical radiculopathy, Outcome 6 Radicular pain (worst‐VAS) at 1 year following treatment.
1.7
1.7. Analysis
Comparison 1 Surgery vs physiotherapy in cervical radiculopathy, Outcome 7 Limb paraesthesia 4 months following treatment.
1.8
1.8. Analysis
Comparison 1 Surgery vs physiotherapy in cervical radiculopathy, Outcome 8 Paraesthesia at 16 months following treatment.
1.9
1.9. Analysis
Comparison 1 Surgery vs physiotherapy in cervical radiculopathy, Outcome 9 Sensory loss at 4 months following treatment.
1.10
1.10. Analysis
Comparison 1 Surgery vs physiotherapy in cervical radiculopathy, Outcome 10 Sensory loss at 16 months following treatment.
2.1
2.1. Analysis
Comparison 2 Surgery vs cervical collar in cervical radiculopathy, Outcome 1 Radicular pain (current‐VAS) at presentation.
2.2
2.2. Analysis
Comparison 2 Surgery vs cervical collar in cervical radiculopathy, Outcome 2 Radicular pain (current‐VAS) at 3 months following treatment.
2.3
2.3. Analysis
Comparison 2 Surgery vs cervical collar in cervical radiculopathy, Outcome 3 Radicular pain (current‐VAS) at 1 year following treatment.
2.4
2.4. Analysis
Comparison 2 Surgery vs cervical collar in cervical radiculopathy, Outcome 4 Radicular pain (worst‐VAS) at presentation.
2.5
2.5. Analysis
Comparison 2 Surgery vs cervical collar in cervical radiculopathy, Outcome 5 Radicular pain (worst‐VAS) at 3 months following treatment.
2.6
2.6. Analysis
Comparison 2 Surgery vs cervical collar in cervical radiculopathy, Outcome 6 Radicular pain (worst‐VAS) at 1 year following treatment.
2.7
2.7. Analysis
Comparison 2 Surgery vs cervical collar in cervical radiculopathy, Outcome 7 Paraesthesia at 4 months following treatment.
2.8
2.8. Analysis
Comparison 2 Surgery vs cervical collar in cervical radiculopathy, Outcome 8 Paraesthesia at 16 months following treatment.
2.9
2.9. Analysis
Comparison 2 Surgery vs cervical collar in cervical radiculopathy, Outcome 9 Sensory loss at 4 months following treatment.
2.10
2.10. Analysis
Comparison 2 Surgery vs cervical collar in cervical radiculopathy, Outcome 10 Sensory loss at 16 months following treatment.
3.1
3.1. Analysis
Comparison 3 conservative vs surgical treatment in cervical myelopathy, Outcome 1 modified JOA score at presentation.
3.2
3.2. Analysis
Comparison 3 conservative vs surgical treatment in cervical myelopathy, Outcome 2 modified JOA score after 6 months.
3.3
3.3. Analysis
Comparison 3 conservative vs surgical treatment in cervical myelopathy, Outcome 3 modified JOA score after 12 months.
3.4
3.4. Analysis
Comparison 3 conservative vs surgical treatment in cervical myelopathy, Outcome 4 modified JOA score after 24 months.
3.5
3.5. Analysis
Comparison 3 conservative vs surgical treatment in cervical myelopathy, Outcome 5 modified JOA score after 36 months.
3.6
3.6. Analysis
Comparison 3 conservative vs surgical treatment in cervical myelopathy, Outcome 6 daily activities evaluation after 6 months.
3.7
3.7. Analysis
Comparison 3 conservative vs surgical treatment in cervical myelopathy, Outcome 7 daily activities evaluation after 12 months.
3.8
3.8. Analysis
Comparison 3 conservative vs surgical treatment in cervical myelopathy, Outcome 8 daily activities evaluation after 24 months.
3.9
3.9. Analysis
Comparison 3 conservative vs surgical treatment in cervical myelopathy, Outcome 9 daily activities evaluation after 36 months.
3.10
3.10. Analysis
Comparison 3 conservative vs surgical treatment in cervical myelopathy, Outcome 10 timed 10‐meter walk at presentation.
3.11
3.11. Analysis
Comparison 3 conservative vs surgical treatment in cervical myelopathy, Outcome 11 timed 10‐meter walk after 6 months.
3.12
3.12. Analysis
Comparison 3 conservative vs surgical treatment in cervical myelopathy, Outcome 12 timed 10‐meter walk after 12 months.
3.13
3.13. Analysis
Comparison 3 conservative vs surgical treatment in cervical myelopathy, Outcome 13 timed 10‐meter walk after 24 months.
3.14
3.14. Analysis
Comparison 3 conservative vs surgical treatment in cervical myelopathy, Outcome 14 timed 10‐meter walk after 36 months.
3.15
3.15. Analysis
Comparison 3 conservative vs surgical treatment in cervical myelopathy, Outcome 15 self evaluation after 6 months.
3.16
3.16. Analysis
Comparison 3 conservative vs surgical treatment in cervical myelopathy, Outcome 16 self evaluation after 12 months.
3.17
3.17. Analysis
Comparison 3 conservative vs surgical treatment in cervical myelopathy, Outcome 17 self evaluation after 24 months.
3.18
3.18. Analysis
Comparison 3 conservative vs surgical treatment in cervical myelopathy, Outcome 18 self evaluation after 36 months.
See this image and copyright information in PMC

Update of

References

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