Management of Cervical Spondylotic Radiculopathy: A Systematic review

Abstract

Objective: (1) To evaluate the effects of surgery and conservative treatments for cervical spondylotic radiculopathy and (2) provide reference for choosing the time and method of treatment.

Methods: A literature search was performed using PubMed, EMbase, The Cochrane Library, Web of Science, and ClinicalTrials from inception to September 2021. Randomized controlled trials (RCTs) on the use of surgery or conservative Treatments in Cervical Spondylotic Radiculopathy (CSR) were selected. The primary outcomes were the neck and arm visual analog scale (VAS) and Neck Disability Index (NDI). Secondary outcomes included active range of cervical motion (ROM) and Mental Health. Two reviewers proceeded study selection and quality assessment.

Results: A total of 6 studies, which comprised a total of 464 participants were included in the final meta-analysis. Compared with conservative treatment, surgical treatment was more effective in lowering Neck-VAS (<3 m: MD = -29.44, 95% CI = (-41.62,-17.27), P < .00001; 3-6 M: MD = -20.97, 95% CI = (-26.36,-15.57), P < .00001; 6 M: MD = -13.40, 95% CI = (-19.39, -7.41), P<.0001; 12 M: MD=-15.53, 95% CI=(-28.38, -2.68), P=.02), Arm-VAS(<3 m: MD = -33.52, 95% CI = (-39.89, -27.16), P < .00001; 3-6 M: MD = -20.97, 95% CI = (-26.36, -15.57), P < .00001; 6 M: MD = -17.52, 95% CI=(-23.94, -11.11), P < .0001; 12 M: MD = -21.91, 95% CI=(-27.09, -16.72), P < .00001) and NDI (<3 m: MD = -8.89, 95% CI = (-11.17, -6.61), P < .00001; 6 M: MD = -5.14, 95% CI = (-7.60, -2.69), P < .0001). No significant difference was observed in NDI at 12-month time point (MD = -5.17, 95% CI = (-12.33, 2.00), P = .16), ROM(MD = 2.91, 95% CI = (-4.51, 10.33), P = .77) and Mental Health (MD = .05, 95% CI=(-.24, .33), P = .74).

Conclusion: The 6 included studies that had low risk of bias, providing high-quality evidence for the surgical efficacy of CSR. The evidence indicates that surgical treatment is better than conservative treatment in terms of VAS score and NDI score, and superior to conservative treatment in less than one year. There was no evidence of a difference between surgical and conservative care in ROM and mental health. A small sample study with a follow-up of 5 to 8 years showed that surgical treatment was still better than conservative treatment, but the sample size was small and the results should be carefully interpreted.Compared with conservative treatment, surgical treatment had a faster onset of response, especially in pain relief, but did not have a significant advantage in range of motion or NDI. This seems to mean that for patients with severe or even unbearable pain, the benefits of surgery as soon as possible will be significant. Although it is not clear whether the short-term risks of surgery are outweighed by the long-term benefits, rapid pain relief is necessary. Conservative treatment (including medical exercise therapy, mechanical cervical tractions, transcutaneous electrical nerve stimulation, pain management education, and cervical collar) once or twice a week for 3 months is beneficial in the long term and avoids the risks of surgery. In consideration of the good natural history of CSR and the relatively good outcome of conservative treatment (although symptom relief is slow), we think that surgery is not necessary for patients who do not need rapid pain relief.

Keywords: Cervical Spondylotic Radiculopathy; Conservative Treatments; Surgery; Systematic review.

Figure 1.

PRISMA 2020 flow diagram.

Figure 2.

Risk of bias summary. Remarks. Green circles indicate a low risk of bias, yellow circles indicate an unclear risk of bias and red circles indicate a high risk of bias.

Figure 3.

Forest plot for Neck VAS.

Figure 4.

Forest plot for Arm VAS.

Figure 5.

Forest plot for Oswestry Disability Index (NDI).

Figure 6.

Forest plot for Active range of cervical motion.

Figure 7.

Forest plot for Mental Health.