Long-lasting cervical radicular pain managed with surgery, physiotherapy, or a cervical collar. A prospective, randomized study

Abstract

Study design: This prospective, randomized study compares the efficacy of surgical and conservative treatments in patients with long-lasting cervical radicular pain.

Objectives: To compare the effects of surgery, physiotherapy, and a cervical collar.

Summary of background data: There are no previous controlled outcome studies that have compared surgical treatment with nonsurgical treatment of patients with cervical radicular pain.

Methods: The study group comprised 81 patients with cervicobrachial pain of at least 3 months' duration, in whom the distribution of the arm pain corresponded to a nerve root that was significantly compressed by spondylotic encroachment with or without an additional bulging disc, as verified by magnetic resonance imaging or computed tomographic myelography. The patients were randomly allocated to surgery (Cloward technique), individually adapted physiotherapy, or a cervical collar. The therapeutic effects were evaluated with respect to pain intensity by the visual analogue scale, function by the Sickness Impact Profile, and mood by Mood Adjective Check List. The measurements were performed before treatment (control 1), shorter after treatment (control 2), and after a further 12 months (control 3).

Results: At control 1, the groups were uniform. At control 2, the surgery group reported less pain (visual analogue scale) and, like the physiotherapy group, better function (Sickness Impact Profile) than the collar group. At control 3, there was no difference in visual analogue scale, Sickness Impact Profile, and Mood Adjective Check List measurements among the groups.

Conclusions: In the treatment of patients with long-lasting cervical radicular pain, it appears that a cervical collar, physiotherapy, or surgery are equally effective in the long term.