Surgery For Cervical Radiculopathy Research Articles

Spine

The February 2023 Spine Roundup360 looks at: S2AI screws: At what cost?; Just how good is spinal deformity surgery?; Is 80 years of age too late in the day for spine surgery?; Factors affecting the accuracy of pedicle screw placement in robot-assisted surgery; Factors causing delay in discharge in patients eligible for ambulatory lumbar fusion surgery; Anterior cervical discectomy or fusion and selective laminoplasty for cervical spondylotic myelopathy; Surgery for cervical radiculopathy: what is the complication burden?; Hypercholesterolemia and neck pain; Return to work after surgery for cervical radiculopathy: a nationwide registry-based observational study.

Predicting adjacent segment disease with deep learning on pre-operative cervical MRI for patients undergoing surgery for cervical radiculopathy

Predicting adjacent segment disease with deep learning on pre-operative cervical MRI for patients undergoing surgery for cervical radiculopathy

Structured rehabilitation in primary health care after surgery for cervical radiculopathy: treatment mediators in a randomized clinical trial

Structured rehabilitation in primary health care after surgery for cervical radiculopathy: treatment mediators in a randomized clinical trial

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

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

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

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

Surgery for cervical radiculopathy or myelopathy

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. . 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. 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. 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". Two authors independently selected trials, assessed risk of bias and extracted data. 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. 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.

Modified Robinson-Smith procedure for the treatment of cervical radiculopathy.

In the present study, a modified Robinson-Smith procedure was used surgery for cervical radiculopathy in 52 patients. Thirty-one one-level and 21 two-level operations were performed. All patients were followed up between 1 and 3 years (mean 23 months) after surgery with a clinical evaluation by an independent investigator including a radiological examination. In 26 patients the postoperative result was classified as excellent, in 23 the result was good, in 2 satisfactory, while one patient was unchanged compared to the preoperative examination. No patient developed worsening of symptoms after surgery. Of 18 patients with duration of symptoms of more than 4 years, 16 demonstrated markedly improvement. No permanent postoperative complications were seen. A modified Robinson-Smith procedure appears to be safe and reliable and can be recommended in surgery for cervical radiculopathy.

Reduced pain after surgery for cervical disc protrusion/stenosis: a 2 year clinical follow-up

Purpose: To follow the clinical outcome after surgery forcervical radiculopathy caused by degenerative cervical discdisease and to compare it with the outcome after conservativetreatment. Methods: Forty-three patients all awaiting surgery were studiedprospectively. A control group of 39 conservatively treatedpatients were chosen, matched for gender and age. All patientsrated their Sickness Impact Profile (SIP) and pain (VAS) andwere clinically examined by unbiased observers initially andafter 3, 9 and 24 months. Results: Long-lasting pain reduction was noted both in theneck and in the arm for the operated patients, as well asimproved sensory function and reduction of reflex disturbances.Their SIP showed a temporary improvement in theoverall index, in the psychosocial dimension, in sleep/rest andhome management, but only mobility remained improved.Among the operated patients referred directly to us, there wasan improvement in SIP at the final follow-up. The controlgroup's SIP indicated only a temporary improvement in sleep/rest. Conclusions: Surgically treated patients experienced painreduction which was partially maintained for at least 24months. A sustained improvement in the health statusmeasured by SIP was observed only among operated patientsthat were not referred via the social insurance offices.