Surgery for cervical radiculopathy followed by physiotherapy may resolve symptoms faster than physiotherapy alone, but with few differences at two years.

Abstract

of: EngquistM, LofgrenH, Oberg B,Holtz A, PeolssonA, Soderlund A, et al. Surgery versus nonsurgical treatment of cervical radiculopathy: a prospective, randomized study comparing surgery plus physiotherapy with physiotherapy alone with a 2-year followup. Spine 2013;20:1715-1722. Question:Does surgery for patients with cervical radiculopathy followed by physiotherapy result in larger long-term improvements in self-reported disability when compared with a physiotherapy program alone? Design: A randomised, controlled trial with concealed allocation and 24 months of follow up. Setting: Three Swedish spinal centres. Participants: Men and women between 18 and 65 years of agewith pain (with or without sensory and motor deficit) in one or both arms indicating nerve root involvement caused by disc herniation with or without osteophytes, or a stenosis caused by osteophytes, confirmed by magnetic resonance imaging. Symptom duration was between eight weeks and five years, and involved one or two symptomatic disc levels. Key exclusion criteria included obvious myelopathy, and previous surgery to the cervical spine. Randomisation allocated 35 to the surgery plus physiotherapy group and 33 to the physiotherapy group. Interventions: Both groups received an individualised physiotherapy program, which included general/ specific exercises and pain-coping strategies, provided twice a week at the clinic for at least three months, in addition to daily home exercises. In addition, the surgery group received an anterior cervical decompression and fusion (ACDF). Outcome measures: Primary outcome was the Neck Disability Index at 24 months. Secondary measures were pain intensity in the neck and arm (0 to