Indications for anterior cervical decompression for the treatment of cervical degenerative radiculopathy

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The objective of this systematic review was to use evidence-based medicine to identify the indications and utility of anterior cervical nerve root decompression.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to surgical management of cervical radiculopathy. Abstracts were reviewed after which studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Anterior nerve root decompression via anterior cervical discectomy (ACD) with or without fusion for radiculopathy is associated with rapid relief (3–4 months) of arm/neck pain, weakness, and/or sensory loss compared with physical therapy (PT) or cervical collar immobilization. Anterior cervical discectomy and ACD with fusion (ACDF) are associated with longer term (12 months) improvement in certain motor functions compared to PT. Other rapid gains observed after anterior decompression (diminished pain, improved sensation, and improved strength in certain muscle groups) are also maintained over the course of 12 months. However, comparable clinical improvements with PT or cervical immobilization therapy are also present in these clinical modalities (Class I). Conflicting evidence exists as to the efficacy of anterior cervical foraminotomy with reported success rates of 52–99% but recurrent symptoms as high as 30% (Class III).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Anterior cervical discectomy, ACDF, and anterior cervical foraminotomy may improve cervical radicular symptoms. With regard to ACD and ACDF compared to PT or cervical immobilization, more rapid relief (within 3–4 months) may be seen with ACD or ACDF with maintenance of gains over the course of 12 months (Class I). Anterior cervical foraminotomy is associated with improvement in clinical function but the quality of data are weaker (Class III), and there is a wide range of efficacy (52–99%).</jats:p></jats:sec>

Use of Thoracic Spine Thrust Manipulation for Neck Pain and Headache in a Patient Following Multiple-Level Anterior Cervical Discectomy and Fusion: A Case Report

“…First, an updated Cochrane review 51 indicated that surgery for cervical radiculopathy or myelopathy may provide more rapid (ie, short-term) pain relief when compared to physical therapy or hard-collar immobilization, primarily based on low-quality evidence, with virtually no difference in the long-term outcomes. Second, Matz et al 49 indicated similar clinical improvements in certain outcomes when comparing anterior surgical nerve root decompression with or without fusion to physical therapy or cervical immobilization at 12 months. Recently, 2 separate studies 31,54 reported on findings from a randomized clinical trial comparing clinical outcomes in patients who received either ACDF followed by physical therapy or physical therapy alone.…”

“…13 Moreover, 2-year reoperation rates following ACDF procedures have been reported to range from 6.2% to 14.5%. 1,23,24,28,50 Two recent systematic reviews 49,51 have provided preliminary support for physical therapy as a form of conservative care for individuals presenting with cervical radiculopathy or myelopathy, prior to considering ACDF surgical intervention. First, an updated Cochrane review 51 indicated that surgery for cervical radiculopathy or myelopathy may provide more rapid (ie, short-term) pain relief when compared to physical therapy or hard-collar immobilization, primarily based on low-quality evidence, with virtually no difference in the long-term outcomes.…”

Nakkesmerter med og uten nerverotsaffeksjon

“…I denne studien fant man ingen sikker forskjell mellom kirurgi og ikke-operativ behandling, men den har vesentlige mangler og deltakerne hadde meget lang symptomvarighet. Gevinsten av kirurgi ser ut til å vaere rask bedring av smertene, langtidseffekten sammenliknet med ikke-operativ behandling er mer usikker (11,13). Et vesentlig spørsmål å stille en pasient med cervikal nerverotsaffeksjon blir derfor om smertene er akseptable i et tidsperspektiv for bedring på 6-12 måne-der.…”

Neck disability in patients with cervical radiculopathy and evaluation of structured postoperative physiotherapy

“…Patients with persistent CR symptoms and unsatisfactory results after non-surgical treatment may be referred to surgery [7,57,68]. Overall, good effects on arm pain and neurological symptoms have been reported after surgery in patients with CR [3,[9][10][11]75].…”

“…Patients with persistent CR symptoms and unsatisfactory results after non-surgical treatment may be referred to surgery [7,57,68]. Surgery primarily aims to address the structural changes in the cervical spine to relieve arm pain and prevent further neurological symptoms by decompressing the nerve root [69].…”