Cochrane review on the role of surgery in cervical spondylotic radiculomyelopathy

Study Design. This study involved a search of MEDLINE (1966 to 2000), EMBASE (1980 to 2000), and the Cochrane Controlled Trials Register. The authors of the identified randomized controlled trials were contacted to detect any additional published or unpublished data. The trials selected for this study included all the truly unconfounded or quasi-randomized controlled investigations allocating patients with cervical radiculopathy or myelopathy to 1) “best medical management” or “decompressive surgery (with or without some form of fusion) plus best medical management,” or 2) “early decompressive surgery” or “delayed decompressive surgery.” Two reviewers independently selected trials for inclusion, assessed trial quality, and extracted the data. Objectives. To determine whether surgical treatment of cervical radiculopathy or myelopathy is associated with improved outcome, as compared with conservative management, and whether the timing of surgery (immediate or delayed because of persistence or progression of relevant symptoms and signs) has an impact on outcome. Summary of Background Data. Cervical spondylosis causes pain and disability by compressing the spinal cord or roots. Surgery to relieve the compression may reduce the pain and disability. However, it is associated with a small but definite risk. This study sought to assess the balance of risk and benefit from surgery. Methods. Two trials involving a total of 130 patients were included. One trial with 81 patients compared surgical decompression with either physiotherapy or cervical collar immobilization in patients with cervical radiculopathy. Results. The short-term effects of surgery, in terms of pain, weakness, or sensory loss were superior. However, at 1 year no significant differences between the groups were observed. Another trial with 49 patients compared the effects of surgery with those of conservative treatment in patients who had a mild functional deficit associated with cervical myelopathy. No significant differences were observed between the groups up to 2 years after treatment. Conclusions. The data from the reviewed trials were inadequate to provide reliable conclusions on the balance of risk and benefit from cervical spine surgery for spondylotic radiculopathy or myelopathy.