title: Evaluation of treatment effectiveness for the herniated cervical disc: a systematic review.
abstract: METHODS
  Systematic review.
  
  
  OBJECTIVE
  To assess the effectiveness of interventions for treating cervical disc herniation.
  
  
  BACKGROUND
  Cervical disc herniation is 1 of the 23 specific disorders included in the CANS (Complaints of the Arm, Neck, and/or Shoulder) model. Treatment options range from conservative to surgical, but evidence for the effectiveness of these interventions is not yet well documented.
  
  
  METHODS
  The Cochrane Library, MEDLINE, EMBASE, PEDro, and CINAHL were searched for relevant systematic reviews and randomized clinical trials (RCTs) up to February 2009. Two reviewers independently selected relevant studies, assessed the methodological quality, and extracted data.
  
  
  RESULTS
  Pooling of the data was not possible; thus, a best-evidence synthesis was used to summarize the results. Of the 11 RCTs included, 1 compared conservative with surgical intervention, and 10 compared various surgical interventions. No evidence was found for the effectiveness of conservative treatment (nonsteroidal anti-inflammatory drugs, cortisonics, and physical therapy) compared with percutaneous nucleoplasty. Moderate evidence was found for the effectiveness of anterior cervical discectomy with fusion (ACDF) using a titanium cage compared with ACDF using polymethyl methacrylate, and for BRYAN cervical disc (Medtronic Sofamor Danek, Memphis, TN) prostheses compared with ACDF using allograft bone and plating. No outcomes regarding adjacent-level disease were reported. There is conflicting evidence for the effectiveness of ACD compared with ACDF. Only limited or no evidence was found for the other surgical interventions.
  
  
  CONCLUSIONS
  No evidence for effectiveness of conservative treatment compared with surgery was found. Although there is moderate evidence for the effectiveness of some surgical interventions, no unequivocal evidence for the superiority of 1 particular surgical treatment was found. Worldwide, most patients receive supplementary implants; however, cervical discectomy without graft may be preferred because of similar outcomes, lower costs, and possibly a lower risk of adjacent-level disease. More high-quality RCTs using validated outcome measures (including adjacent level disease) are needed.
authors.affiliation: Erasmus Medical Center, Department of General Practice, Rotterdam, The Netherlands.
authors.forename: Lukas
authors.initials: L
authors.lastname: Gebremariam
authors.forename: Bart W
authors.initials: BW
authors.lastname: Koes
authors.forename: Wilco C
authors.initials: WC
authors.lastname: Peul
authors.forename: Bionka M
authors.initials: BM
authors.lastname: Huisstede
mesh_terms: D002574:Cervical Vertebrae / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D017586:Diskectomy / Q000379:methods / Q000523:psychology; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019547:Neck Pain / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D013123:Spinal Fusion / Q000379:methods / Q000523:psychology; D055009:Spondylosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome