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Surgical Treatment of Cervical Radiculopathy

Meta-analysis of Randomized Controlled Trials

Gutman, Gabriel, MD∗,†; Rosenzweig, Derek H., PhD; Golan, Jeff D., MD, FRCS(c)∗,†

doi: 10.1097/BRS.0000000000002324

Study Design. Meta-analysis of published randomized controlled trials (RCTs).

Objective. To determine whether anterior cervical discectomy and fusion (ACDF), cervical disc replacement (CDR), or minimally invasive posterior cervical foraminotomy (MI-PCF) provides the best outcomes for patients with symptomatic single-level, single-side, and cervical radiculopathy.

Summary of Background Data. The surgical treatment of cervical radiculopathy is still controversial. ACDF has been widely used as a “gold standard.” CDR has evolved and become a motion-preserving alternative with a potentially lower incidence of adjacent segment disease. However, both techniques require anterior neck dissection that carries a potential for serious morbidity. MI-PCF is a motion-preserving technique that can be performed with minimal invasiveness but has not gained universal acceptance.

Methods. Electronic database search for RCTs comparing the efficacy and effectiveness of ACDF, CDR, and MI-PCF was performed. Meta-analysis was done for secondary surgical procedures and adverse events.

Results. A total of 358 studies were retrieved, of which four RCT reports met the inclusion criteria for this study. Three studies present clinical data comparing ACDF and CDR, and one study presents data comparing ACDF and MI-PCF. Available data from the RCTs analyzed concluded that ACDF, CDR, and MI-PCF result in significant improvements in relevant symptoms, clinical, and functional outcomes in patients with single-level, single side cervical radiculopathy refractory to nonoperative treatment. CDR had the lowest percentage of secondary surgical procedures (P = 0.0178) whereas MICPF had the lowest percentage of adverse events (P < 0.0001).

Conclusion. All three techniques are effective in treating cervical radicular symptoms. MI-PCF has the lowest rate of adverse events whereas CDR has the lowest rate of secondary procedures. There is insufficient evidence to show which technique is the most effective and provides the longest-lasting symptom relief.

Level of Evidence: 1

Department of Neurosurgery, Jewish General Hospital, Montreal, Quebec, Canada

Department of Neurosurgery, McGill University, Montreal, Quebec, Canada

Department of Surgery, McGill University, Montreal, Quebec, Canada.

Address correspondence and reprint requests to Jeff D. Golan, MD, FRCS(c), Department of Neurosurgery, Division of Neurosurgery, Jewish General Hospital, Montreal, QC, Canada; E-mail:

Received 22 March, 2017

Revised 12 June, 2017

Accepted 16 June, 2017

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

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