Surgery Versus Nonsurgical Treatment of Cervical Radiculopathy
The primary treatment of patients with cervical radiculopathy (CR) is conservative and includes pain management and physiotherapy. When pain persists for more than 3 months or a more rapid recovery is wanted, surgical treatment (anterior cervical decompression and fusion (ACDF)) could be suggested. This prospective RCT compares ACDF with a structured physiotherapy (PT) (n=31) program to the same PT program alone (n=32) for patients with CR.
The PT treatment included neck-specific and general exercises, procedures for pain relief and pain coping, increasing self-efficacy and stress management strategies. The same procedure started 3 months after surgery. The follow-up measurements were at 6, 12 and 24 months.
Both groups showed a reduction on the Neck Disability Index and arm pain intensity with no significant differences between groups. Neck pain decreased in both groups however a significant difference in favor of the surgical group was present at 12 months. The patients’ global assessment was significant better for the surgery group after 12 months, however no significant differences were present at 24 months.
This study showed that the combination of surgery with physiotherapy has better results at short term (till 12 months) however the differences between the groups decreased with time. The authors suggest that patients with CR should initially be treated with PT and that surgery should be reserved for the non-responders. > From: Engquist et al. Spine (2013) (Epub ahead of print). All rights reserved to Lippincott Williams & Wilkins
The Pubmed summary of the article can be found here.
See the operation mentioned in the article in the YouTube clip below: anterior cervical decompression and fusion.
See an example [red. A&P] of pain education in the YouTube clip below. Teaching the patients about pain was one of the treatments, next to general/specific exercises, the physiotherapy group reveived.