Surgery Versus Non-Surgical Treatment for Cervical Radiculopathy

A prospective, randomized study comparing surgery plus physiotherapy with physiotherapy alone with a two year follow-up

Engquist, Markus MD

Abstract
Study Design. Prospective randomized controlled trial.

Objective. To 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 Data. Knowledge concerning the effects of interventions for patients with cervical radiculopathy is scarce due to a lack of randomized studies.

Methods. 63 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.

Results. The 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).

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).

Conclusion. In 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.

(C) 2013 by Lippincott Williams & Wilkins

Journal Website Abstract:  http://journals.lww.com/spinejournal/Abstract/publishahead/Surgery_Versus_Non_Surgical_Treatment_for_Cervical.97698.aspx