Surgical Versus Nonsurgical Treatment for Cervical Radiculopathy: A Systematic Review and Meta-analysis
Shams Albarari1, Noon Elimam2, Yara Shaalan3, Rahaf Mogahed4, Nourhan Elmekkawi5, Arwa Abdelaziz6, Eman Fathy7, Rewan Ramadan6, Ainaa A.Alzamar8
1Tbilisi State Medical University, Tbilisi, Georgia, 2Bogomolets National Medical University, Kyiv, Ukraine, 3Misr University for Science and Technology, 6th of October City, Egypt, 46th of October University, 6th of October City, Egypt, 5Zifta General Hospital, Egypt, 6Mansoura University, Mansoura, Egypt, 7Cairo University; Damietta General Hospital, 8Al-Quds University, Palestine
Objective:
To systematically compare the effectiveness of surgical and non-surgical management for cervical radiculopathy on patient-reported outcomes, including functional disability, pain, and global improvement.
Background:
Cervical radiculopathy is the second most common radiculopathy, causing significant neck and radiating arm pain. While both surgical and conservative treatments are used, a discussion about their comparative long-term effectiveness on functional and pain-related outcomes remains ongoing.
Design/Methods:
We systematically searched PubMed, Scopus, and Cochrane Central Register of Controlled Trials for comparative studies. Eligible studies included patients diagnosed with CR undergoing surgical intervention (like ACDF) or non-surgical management (like physiotherapy). The primary outcome was the Neck Disability Index (NDI). Secondary outcomes included Visual Analog Scale (VAS) scores for arm and neck pain, and patient-reported improvement rates. Data were pooled using a random-effects model.
Results:
Five studies (N=318 patients) met the inclusion criteria. The meta-analysis showed that surgical intervention led to statistically significant greater reductions in both arm pain (MD: -1.25, 95% CI: -1.71 to -0.78) and neck pain (MD: -0.84, 95% CI: -1.35 to -0.32) compared to non-surgical procedures. Patients in the surgical group were 33% more likely to report feeling "better" or "much better" (RR: 1.33, 95% CI: 1.07 to 1.65). For functional recovery (NDI), no significant difference was found at short-term (12-month) follow-up. However, a single long-term study (5-8 years) showed a clinically meaningful advantage for surgery.
Conclusions:
This study suggests that surgery provides more significant benefits for pain relief than non-surgical strategies. The potential for superior functional recovery appears to emerge only in the long term, but this conclusion is based on limited evidence. Therefore, while surgery is an effective option, careful patient selection and shared decision-making are essential for optimizing individual outcomes.
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