Friday, September 27, 2013
From the Desk of Markus Engquist, MD
We thank the editor, Dr. Pearson for his comment on our study, which in an excellent way describes both the difficulties performing this kind of study, as well as the conclusions that could be made. We believe that the study underscores the hypothesis that surgery leads to more rapid improvement regarding pain and overall satisfaction than physiotherapy alone and that these differences decrease with time. It is a correct assumption that the study may be underpowered regarding some of the outcome measures and that further differences might have been detected with a greater number of patients as all non-significant trends were in favor of the surgical group. We also used an extensive, structured physiotherapy program, which alone had a good effect for many patients and should be tried before surgery. For non-operatively treated patients who don't have access to such a program, the course of the disease might be less favorable.
In our clinical practice, the study has given us a basis for scientifically based information to the patient when choosing between operative or non-operative treatment. This increases the possibility for the patient to make a well-informed choice. When choosing non-operative treatment, we believe it to be important to have a structured program for physiotherapy, with physiotherapists interested and trained in treating neck disorders. A more detailed description of the program that was used in this study can be found in our article “Physical function outcome in cervical radiculopathy patients after physiotherapy alone compared with anterior surgery followed by physiotherapy: a prospective randomized study with a 2-year follow-up.”, published in Spine 2013 Feb 15;38(4):300-7.