title: CASINO: surgical or nonsurgical treatment for cervical radiculopathy, a randomised controlled trial.
abstract: BACKGROUND
  Cervical radicular syndrome (CRS) due to a herniated disc can be safely treated by surgical decompression of the spinal root. In the vast majority of cases this relieves pain in the arm and restores function. However, conservative treatment also has a high chance on relieving symptoms. The objective of the present study is to evaluate the (cost-) effectiveness of surgery versus prolonged conservative care during one year of follow-up, and to evaluate the timing of surgery. Predisposing factors in favour of one of the two treatments will be evaluated.
  
  
  METHODS
  Patients with disabling radicular arm pain, suffering for at least 2 months, and an MRI-proven herniated cervical disc will be randomised to receive either surgery or prolonged conservative care with surgery if needed. The surgical intervention will be an anterior discectomy or a posterior foraminotomy that is carried out according to usual care. Surgery will take place within 2-4 weeks after randomisation. Conservative care starts immediately after randomisation. The primary outcome measure is the VAS for pain or tingling sensations in the arm one year after randomisation. In addition, timing of surgery will be studied by correlating the primary outcome to the duration of symptoms. Secondary outcome measures encompass quality of life, costs and perceived recovery. Predefined prognostic factors will be evaluated. The total follow-up period will cover two years. A sample size of 400 patients is needed. Statistical analysis will be performed using a linear mixed model which will be based on the 'intention to treat' principle. In addition, a new CRS questionnaire for patients will be developed, the Leiden Cervical Radicular Syndrome Functioning (LCRSF) scale.
  
  
  CONCLUSIONS
  The outcome will contribute to better decision making for the treatment of cervical radicular syndrome.
  
  
  BACKGROUND
  NTR3504.
authors.forename: Sarita
authors.initials: S
authors.lastname: van Geest
authors.forename: Barbara
authors.initials: B
authors.lastname: Kuijper
authors.forename: Marinus
authors.initials: M
authors.lastname: Oterdoom
authors.forename: Wilbert
authors.initials: W
authors.lastname: van den Hout
authors.forename: Ronald
authors.initials: R
authors.lastname: Brand
authors.forename: Theo
authors.initials: T
authors.lastname: Stijnen
authors.forename: Pim
authors.initials: P
authors.lastname: Assendelft
authors.forename: Bart
authors.initials: B
authors.lastname: Koes
authors.forename: Wilco
authors.initials: W
authors.lastname: Jacobs
authors.forename: Wilco
authors.initials: W
authors.lastname: Peul
authors.affiliation: Department of Neurosurgery, Leiden University Medical Center (LUMC), P,O, Box 9600, NL-2300 RC Leiden, the Netherlands. Cvleggeert@lumc.nl.
authors.forename: Carmen
authors.initials: C
authors.lastname: Vleggeert-Lankamp
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011843:Radiculopathy / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
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