Treatment of neck pain: injections and surgical interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.
METHODS
Best evidence synthesis.


OBJECTIVE
To identify, critically appraise, and synthesize literature from 1980 through 2006 on surgical interventions for neck pain alone or with radicular pain in the absence of serious pathologic disease.


BACKGROUND
There have been no comprehensive systematic literature or evidence-based reviews published on this topic.


METHODS
We systematically searched Medline for literature published from 1980 to 2006 on percutaneous and open surgical interventions for neck pain. Publications on the topic were also solicited from experts in the field. Consensus decisions were made about the scientific merit of each article; those judged to have adequate internal validity were included in our Best Evidence Synthesis.


RESULTS
Of the 31,878 articles screened, 1203 studies were relevant to the Neck Pain Task Force mandate and of these, 31 regarding treatment by surgery or injections were accepted as scientifically admissible. Radiofrequency neurotomy, cervical facet injections, cervical fusion and cervical arthroplasty for neck pain without radiculopathy are not supported by current evidence. We found there is support for short-term symptomatic improvement of radicular symptoms with epidural corticosteroids. It is not clear from the evidence that long-term outcomes are improved with the surgical treatment of cervical radiculopathy compared to nonoperative measures. However, relatively rapid and substantial symptomatic relief after surgical treatment seems to be reliably achieved. It is not evident that one open surgical technique is clearly superior to others for radiculopathy. Cervical foramenal or epidural injections are associated with relatively frequent minor adverse events (5%-20%); however, serious adverse events are very uncommon (<1%). After open surgical procedures on the cervical spine, potentially serious acute complications are seen in approximately 4% of patients.


CONCLUSIONS
Surgical treatment and limited injection procedures for cervical radicular symptoms may be reasonably considered in patients with severe impairments. Percutaneous and open surgical treatment for neck pain alone, without radicular symptoms or clear serious pathology, seems to lack scientific support.
Carragee
Eugene J
EJ
Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA. carragee@leland.stanford.edu
Hurwitz
Eric L
EL
Cheng
Ivan
I
Carroll
Linda J
LJ
Nordin
Margareta
M
Guzman
Jaime
J
Peloso
Paul
P
Holm
Lena W
LW
Côté
Pierre
P
Hogg-Johnson
Sheilah
S
van der Velde
Gabrielle
G
Cassidy
J David
JD
Haldeman
Scott
S
D000779:Anesthetics, Local / Q000627:therapeutic use; D019299:Decompression, Surgical / Q000706:statistics & numerical data; D006801:Humans; D007267:Injections / Q000706:statistics & numerical data; D019547:Neck Pain / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D011843:Radiculopathy / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D018570:Risk Assessment; D013123:Spinal Fusion / Q000706:statistics & numerical data; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome
D000779:Anesthetics, Local; D013256:Steroids