Clinical Efficacy and Safety of Surgical Treatments in Patients With Pure Cervical Radiculopathy

Abstract

BackgroundTraditionally paired meta-analysis revealed inconsistencies in the safety and effectiveness of surgical interventions. We conducted a network meta-analysis to assess various treatments' clinical efficacy and safety for pure cervical radiculopathy.MethodsThe Embase, PubMed, and Cochrane Library databases were searched for randomized controlled trials (RCTs) comparing different treatment options for patients with pure cervical radiculopathy from inception until October 23, 2021. The primary outcomes were postoperative success rates, postoperative complication rates, and postoperative reoperation rates. The pooled data were subjected to a random-effects consistency model. The protocol was published in PROSPERO (CRD42021284819).ResultsThis study included 23 RCTs (n = 1,844) that evaluated various treatments for patients with pure cervical radiculopathy. There were no statistical differences between treatments in the consistency model in terms of major clinical effectiveness and safety outcomes. Postoperative success rates were higher for anterior cervical foraminotomy (ACF: probability 38%), posterior cervical foraminotomy (PCF: 24%), and anterior cervical discectomy with fusion and additional plating (ACDFP: 21%). Postoperative complication rates ranked from high to low as follows: cervical disc replacement (CDR: probability 32%), physiotherapy (25%), ACF (25%). Autologous bone graft (ABG) had better relief from arm pain (probability 71%) and neck disability (71%). Among the seven surgical interventions with a statistical difference, anterior cervical discectomy with allograft bone graft plus plating (ABGP) had the shortest surgery time.ConclusionsAccording to current results, all surgical interventions can achieve satisfactory results, and there are no statistically significant differences. As a result, based on their strengths and patient-related factors, surgeons can exercise discretion in determining the appropriate surgical intervention for pure cervical radiculopathy.Systematic Review Registration: CRD42021284819.

Age and flexors as risk factors for cervical radiculopathy: A new machine learning method

“…Cervical radiculopathy (CR), an aging-related disease, typically manifests as neck and shoulder pain, ultimately resulting in atrophy of cervical paraspinal muscles (PSMs). [1] Its epidemiological characteristics have extensively been investigated worldwide, especially since the world is approaching an aging society. Its age-adjusted incidence is 83 per 100,000 people.…”

“…Its age-adjusted incidence is 83 per 100,000 people. [1] Strine and Hootman showed that approximately one-third of the US population is suffering from CR, i.e., neck pain and muscle dysfunction, representing a significant medical and economic burden. [2] A recent meta-analysis, including the subgroup analysis of 1202 individuals, estimated a 2.3% overall prevalence of CR and a 24.2% prevalence of asymptomatic nerve compression, with the elderly population exhibiting a significantly higher prevalence.…”

Impact of Posterior Cervical Foraminotomy Before or After Cervical Disk Replacement

“…A variety of surgical approaches and procedures have been described to treat radicular symptoms related to cervical degenerative pathology in patients who are un-responsive to conservative treatment or those with clinical symptoms of myelopathy. [1][2][3][4][5][6] The primary goal of operative treatment in patients with radiculopathy alone is decompression of the cervical nerve root to decrease pain and allow for improvement in sensory or motor deficits. 7 The most common surgical options for treating cervical radiculopathy are anterior cervical discectomy and fusion (ACDF), posterior cervical foraminotomy (PCF), and cervical disk replacement (CDR).…”

“…A variety of surgical approaches and procedures have been described to treat radicular symptoms related to cervical degenerative pathology in patients who are unresponsive to conservative treatment or those with clinical symptoms of myelopathy 1–6 . The primary goal of operative treatment in patients with radiculopathy alone is decompression of the cervical nerve root to decrease pain and allow for improvement in sensory or motor deficits 7 .…”