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Surgery Versus Nonsurgical Treatment of Cervical Radiculopathy: A Prospective, Randomized Study Comparing Surgery Plus Physiotherapy With Physiotherapy Alone With a 2-Year Follow-up

Engquist, Markus MD*,†; Löfgren, Håkan MD, PhD; Öberg, Birgitta PhD, RPT§; Holtz, Anders MD, PhD; Peolsson, Anneli PhD, RPT§; Söderlund, Anne PhD, RPT; Vavruch, Ludek MD, PhD; Lind, Bengt MD, PhD**,††

Spine:
doi: 10.1097/BRS.0b013e31829ff095
Randomized Trial
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Abstract

Study Design. Prospective randomized controlled trial.

Objective. To study the outcome of anterior cervical decompression and fusion combined with a structured physiotherapy program compared with the same physiotherapy program alone for patients with cervical radiculopathy.

Summary of Background Data. Knowledge concerning the effects of interventions for patients with cervical radiculopathy is scarce due to a lack of randomized studies.

Methods. Sixty-three patients were randomized to surgery with postoperative physiotherapy (n = 31) or physiotherapy alone (n = 32). The surgical group was treated with anterior cervical decompression and fusion. The physiotherapy program included general/specific exercises and pain-coping strategies. The outcome measures were disability (Neck Disability Index), neck and arm pain intensity (visual analogue scale), and the patient's global assessment. Patients were followed for 24 months.

Results. The result from the repeated-measures analysis of variance showed no significant between-group difference for Neck Disability Index (P = 0.23). For neck pain intensity, the repeated-measures analysis of variance showed a significant between-group difference during the study period in favor of the surgical group (P = 0.039). For arm pain intensity, no significant between-group differences were found according to the repeated-measures analysis of variance (P = 0.580). Eighty-seven percent of the patients in the surgical group rated their symptoms as “better/much better” at the 12-month follow-up compared with 62% in the nonsurgical group (P < 0.05). At 24 months, the corresponding figures were 81% and 69% (P = 0.28). The difference was significant only at the 12-month follow-up in favor of the surgical group. Significant reduction in Neck Disability Index, neck pain, and arm pain compared with baseline was seen in both groups (P < 0.001).

Conclusion. In this prospective, randomized study of patients with cervical radiculopathy, it was shown that surgery with physiotherapy resulted in a more rapid improvement during the first postoperative year, with significantly greater improvement in neck pain and the patient's global assessment than physiotherapy alone, but the differences between the groups decreased after 2 years. Structured physiotherapy should be tried before surgery is chosen.

Level of Evidence: 2

In Brief

A prospective, randomized study comparing surgery plus physiotherapy with physiotherapy alone for patients with cervical radiculopathy was conducted. Surgery resulted in a more rapid improvement during the first postoperative year, with significantly greater improvement in neck pain and the patient&amp;#x0027;s global assessment than physiotherapy alone, but the differences between the groups decreased after 2 years.

Author Information

*Department of Orthopaedics, Ryhov Hospital, Jönköping, Sweden; and

Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

Neuro-orthopedic Center, Ryhov Hospital, Jönköping, Sweden

§Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Health Sciences, Linköping University, Linköping, Sweden

Department of Neuroscience, Neurosurgery, Uppsala University Hospital, Uppsala, Sweden

Department of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden; and

**Spine Center Göteborg, Gothenburg, Sweden; and

††Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Address correspondence and reprint requests to Markus Engquist, MD, Department of Orthopaedics, Ryhov Hospital, S-551 85 Jönköping, Sweden; E-mail: markus.engquist@lj.se

Acknowledgment date: April 4, 2012. First revision date: September 2, 2012. Second revision date: May 8, 2013. Acceptance date: June 6, 2013.

The device(s)/drug(s) is/are FDA approved or approved by corresponding national agency for this indication.

Medical Research Council of Southeast Sweden funds were received to support this work.

Relevant financial activities outside the submitted work: payment for writing or reviewing the manuscript and consultancy.

© 2013 by Lippincott Williams & Wilkins