title: A 5- to 8-year randomized study on the treatment of cervical radiculopathy: anterior cervical decompression and fusion plus physiotherapy versus physiotherapy alone.
abstract: OBJECTIVE The aim of this study was to evaluate the 5- to 8-year outcome of anterior cervical decompression and fusion (ACDF) combined with a structured physiotherapy program as compared with that following the same physiotherapy program alone in patients with cervical radiculopathy. No previous prospective randomized studies with a follow-up of more than 2 years have compared outcomes of surgical versus nonsurgical intervention for cervical radiculopathy. METHODS Fifty-nine patients were randomized to ACDF surgery with postoperative physiotherapy (30 patients) or to structured physiotherapy alone (29 patients). The physiotherapy program included general and specific exercises as well as pain coping strategies. Outcome measures included neck disability (Neck Disability Index [NDI]), neck and arm pain intensity (visual analog scale [VAS]), health state (EQ-5D questionnaire), and a patient global assessment. Patients were followed up for 5-8 years. RESULTS After 5-8 years, the NDI was reduced by a mean score% of 21 (95% CI 14-28) in the surgical group and 11% (95% CI 4%-18%) in the nonsurgical group (p = 0.03). Neck pain was reduced by a mean score of 39 mm (95% CI 26-53 mm) compared with 19 mm (95% CI 7-30 mm; p = 0.01), and arm pain was reduced by a mean score of 33 mm (95% CI 18-49 mm) compared with 19 mm (95% CI 7-32 mm; p = 0.1), respectively. The EQ-5D had a mean respective increase of 0.29 (95% CI 0.13-0.45) compared with 0.14 (95% CI 0.01-0.27; p = 0.12). Ninety-three percent of patients in the surgical group rated their symptoms as "better" or "much better" compared with 62% in the nonsurgical group (p = 0.005). Both treatment groups experienced significant improvement over baseline for all outcome measures. CONCLUSIONS In this prospective randomized study of 5- to 8-year outcomes of surgical versus nonsurgical treatment in patients with cervical radiculopathy, ACDF combined with physiotherapy reduced neck disability and neck pain more effectively than physiotherapy alone. Self-rating by patients as regards treatment outcome was also superior in the surgery group. No significant differences were seen between the 2 patient groups as regards arm pain and health outcome.
authors: Department of Orthopaedics, Ryhov Hospital.
authors: Markus
authors: M
authors: Engquist
authors: Neuro-Orthopedic Center, Ryhov Hospital, Jönköping.
authors: Håkan
authors: H
authors: Löfgren
authors: Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Health Sciences, Linköping University, Linköping.
authors: Birgitta
authors: B
authors: Öberg
authors: Department of Neuroscience, Neurosurgery, Uppsala University Hospital, Uppsala.
authors: Anders
authors: A
authors: Holtz
authors: Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Health Sciences, Linköping University, Linköping.
authors: Anneli
authors: A
authors: Peolsson
authors: Department of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Västerås; and.
authors: Anne
authors: A
authors: Söderlund
authors: Neuro-Orthopedic Center, Ryhov Hospital, Jönköping.
authors: Ludek
authors: L
authors: Vavruch
authors: Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg.|Spine Center Göteborg, Gothenburg, Sweden.
authors: Bengt
authors: B
authors: Lind
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery; D019299:Decompression, Surgical / Q000379:methods*; D004185:Disability Evaluation; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology / Q000534:rehabilitation / Q000601:surgery; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement; D011446:Prospective Studies; D011843:Radiculopathy / Q000150:complications / Q000534:rehabilitation* / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: ACDF = anterior cervical decompression and fusion; NDI = Neck Disability Index; VAS = visual analog scale; anterior cervical decompression and fusion; cervical radiculopathy; outcome; physiotherapy; randomized; surgery