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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

Peolsson, Anneli PhD, RPT*; Söderlund, Anne PhD, PT; Engquist, Markus MD‡,§; Lind, Bengt MD, PhD§,¶; Löfgren, Håkan MD, PhD; Vavruch, Ludek MD, PhD; Holtz, Anders MD, PhD**; Winström-Christersson, Annelie BSc††; Isaksson, Ingrid BSc††; Öberg, Birgitta PhD, PT*

doi: 10.1097/BRS.0b013e31826d2cbb
Randomized Trial

Study Design. Prospective randomized study.

Objective. To investigate differences in physical functional outcome in patients with radiculopathy due to cervical disc disease, after structured physiotherapy alone (consisting of neck-specific exercises with a cognitive-behavioral approach) versus after anterior cervical decompression and fusion (ACDF) followed by the same structured physiotherapy program.

Summary of Background Data. No earlier studies have evaluated the effectiveness of a structured physiotherapy program or postoperative physical rehabilitation after ACDF for patients with magnetic resonance imaging–verified nerve compression due to cervical disc disease.

Methods. Our prospective randomized study included 63 patients with radiculopathy and magnetic resonance imaging–verified nerve root compression, who were randomized to receive either ACDF in combination with physiotherapy or physiotherapy alone. For 49 of these patients, an independent examiner measured functional outcomes, including active range of neck motion, neck muscle endurance, and hand-related functioning before treatment and at 3-, 6-, 12-, and 24-month follow-ups.

Results. There were no significant differences between the 2 treatment alternatives in any of the measurements performed (P = 0.17–0.91). Both groups showed improvements over time in neck muscle endurance (P ≤ 0.01), manual dexterity (P ≤ 0.03), and right-handgrip strength (P = 0.01).

Conclusion. Compared with a structured physiotherapy program alone, ACDF followed by physiotherapy did not result in additional improvements in neck active range of motion, neck muscle endurance, or hand-related function in patients with radiculopathy. We suggest that a structured physiotherapy program should precede a decision for ACDF intervention in patients with radiculopathy, to reduce the need for surgery.

Level of Evidence: 2

In this prospective randomized study of patients with radiculopathy due to cervical disc disease, combination of anterior surgery and structured physiotherapy did not result in additional improvements in independently measured physical function compared with physiotherapy alone. We thereby suggest that a structured physiotherapy program should precede a decision for surgery.

*Department of Physiotherapy, Faculty of Health Sciences, Linköping University, Linköping, Sweden

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

Department of Orthopedics, Ryhov Hospital, Jönköping, Sweden

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

Spine Center, Gothenburg, Sweden

Neuro-Orthopedic Center, Ryhov Hospital, Jönköping, Sweden

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

††Department of Physiotherapy, Ryhov Hospital, Jönköping, Sweden.

Address correspondence and reprint requests to Anneli Peolsson, PhD, RPT, Department of Physiotherapy, Faculty of Health Sciences, SE-581 83, Linköping University, Linköping, Sweden; E-mail:

Acknowledgment date: April 18, 2012. First revision date: July 2, 2012. Acceptance date: July 30, 2012.

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

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

One or more of the author(s) has/have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript: e.g., honoraria, gifts, consultancies, royalties, stocks, stock options, decision making position.

© 2013 Lippincott Williams & Wilkins, Inc.