Appraising The Evidence for Conservative Versus Surgical Management of Motor Deficits in Degenerative Cervical Radiculopathy

Overview

Journal Global Spine J

Publisher Sage Publications

Date 2022 Jun 16

PMID 35708971

Authors

Axumawi Gebreyohanes

Marios Erotocritou

David Choi

Affiliations

Soon will be listed here.

Abstract

Study Design: Systematic review.

Objectives: Understanding the prevalence and outcome of motor deficits in degenerative cervical radiculopathy is important to guide management. We compared motor radiculopathy outcomes after conservative and surgical management, a particular focus being painful vs painless radiculopathy.

Methods: MEDLINE and EMBASE databases were searched. We stratified each study cohort into 1 of 6 groups, I-VI, based on whether radiculopathy was painful, painless or unspecified, and whether interventions were surgical or non-surgical.

Results: Of 10 514 initial studies, 44 matched the selection criteria. Whilst 42 (95.5%) provided baseline motor radiculopathy data, only 22 (50.0%) provided follow-up motor outcomes. Mean baseline prevalence of motor deficits was 39.1% (9.2%-73.3%) in conservative cohorts and 60.5% (18.5%-94.1%) in surgical cohorts. Group VI, 'surgically-managed motor radiculopathy with unclear pain status' had the largest number of cohorts. Conversely, no cohorts were found in Group III, 'conservatively-managed painless motor radiculopathy'. Large disparities in data quality made direct comparison of conservative vs operative management difficult.

Conclusions: Overall pre-intervention prevalence of motor deficits in degenerative cervical radiculopathy is 56.4%. Many studies fail to report motor outcomes after intervention, meaning statistical evidence to guide optimal management of motor radiculopathy is currently lacking. Our study highlights the need for more evidence, preferably from a prospective long-term study, to allow direct comparisons of motor outcomes after conservative and surgical management.

References

Church E, Halpern C, Faught R, Balmuri U, Attiah M, Hayden S . Cervical laminoforaminotomy for radiculopathy: Symptomatic and functional outcomes in a large cohort with long-term follow-up. Surg Neurol Int. 2015; 5(Suppl 15):S536-43. PMC: 4287901. DOI: 10.4103/2152-7806.148029. View

Xiao L, Li J, Li D, Yan D, Yang J, Wang D . A posterior approach to cervical nerve root block and pulsed radiofrequency treatment for cervical radicular pain: a retrospective study. J Clin Anesth. 2015; 27(6):486-91. DOI: 10.1016/j.jclinane.2015.04.007. View

Liberati A, Altman D, Tetzlaff J, Mulrow C, Gotzsche P, Ioannidis J . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009; 6(7):e1000100. PMC: 2707010. DOI: 10.1371/journal.pmed.1000100. View

Bacigaluppi S, Bragazzi N, Zella S, Prada F, Zavanone M, Rampini P . Reappraisal of the posterior approach for cervical decompressive herniectomy. J Neurosurg Sci. 2016; 63(1):30-35. DOI: 10.23736/S0390-5616.16.03774-7. View

Lee S, Kim K, Kim D, Lee B, Son E, Kwack Y . Clinical outcomes of cervical radiculopathy following epidural steroid injection: a prospective study with follow-up for more than 2 years. Spine (Phila Pa 1976). 2011; 37(12):1041-7. DOI: 10.1097/BRS.0b013e31823b4d1f. View

Lunsford L, Bissonette D, Jannetta P, Sheptak P, Zorub D . Anterior surgery for cervical disc disease. Part 1: Treatment of lateral cervical disc herniation in 253 cases. J Neurosurg. 1980; 53(1):1-11. DOI: 10.3171/jns.1980.53.1.0001. View

Heckmann J, Lang C, Zobelein I, Laumer R, Druschky A, Neundorfer B . Herniated cervical intervertebral discs with radiculopathy: an outcome study of conservatively or surgically treated patients. J Spinal Disord. 1999; 12(5):396-401. View

Cornelius J, Bruneau M, George B . Microsurgical cervical nerve root decompression via an anterolateral approach: clinical outcome of patients treated for spondylotic radiculopathy. Neurosurgery. 2007; 61(5):972-80. DOI: 10.1227/01.neu.0000303193.64802.8f. View

SWEZEY R . Conservative treatment of cervical radiculopathy. J Clin Rheumatol. 2008; 5(2):65-73. DOI: 10.1097/00124743-199904000-00006. View

10.

Hamburger C, Festenberg F, Uhl E . Ventral discectomy with pmma interbody fusion for cervical disc disease: long-term results in 249 patients. Spine (Phila Pa 1976). 2001; 26(3):249-55. DOI: 10.1097/00007632-200102010-00009. View

11.

Ruetten S, Komp M, Merk H, Godolias G . A new full-endoscopic technique for cervical posterior foraminotomy in the treatment of lateral disc herniations using 6.9-mm endoscopes: prospective 2-year results of 87 patients. Minim Invasive Neurosurg. 2007; 50(4):219-26. DOI: 10.1055/s-2007-985860. View

12.

ODOM G, FINNEY W, WOODHALL B . Cervical disk lesions. J Am Med Assoc. 1958; 166(1):23-8. DOI: 10.1001/jama.1958.02990010025006. View

13.

Kim K, Cho D, Sung J, Kim Y, Kim D . Comparative Analysis between Total Disc Replacement and Posterior Foraminotomy for Posterolateral Soft Disc Herniation with Unilateral Radiculopathy : Clinical and Biomechanical Results of a Minimum 5 Years Follow-up. J Korean Neurosurg Soc. 2017; 60(1):30-39. PMC: 5223749. DOI: 10.3340/jkns.2015.0506.004. View

14.

Persson L, MORITZ U, Brandt L, Carlsson C . Cervical radiculopathy: pain, muscle weakness and sensory loss in patients with cervical radiculopathy treated with surgery, physiotherapy or cervical collar. A prospective, controlled study. Eur Spine J. 1997; 6(4):256-66. PMC: 3454639. DOI: 10.1007/BF01322448. View

15.

Bertalanffy H, Eggert H . Clinical long-term results of anterior discectomy without fusion for treatment of cervical radiculopathy and myelopathy. A follow-up of 164 cases. Acta Neurochir (Wien). 1988; 90(3-4):127-35. DOI: 10.1007/BF01560567. View

16.

MacDowall A, Skeppholm M, Lindhagen L, Robinson Y, Lofgren H, Michaelsson K . Artificial disc replacement versus fusion in patients with cervical degenerative disc disease with radiculopathy: 5-year outcomes from the National Swedish Spine Register. J Neurosurg Spine. 2018; 30(2):159-167. DOI: 10.3171/2018.7.SPINE18657. View

17.

Adamson T . Microendoscopic posterior cervical laminoforaminotomy for unilateral radiculopathy: results of a new technique in 100 cases. J Neurosurg. 2001; 95(1 Suppl):51-7. DOI: 10.3171/spi.2001.95.1.0051. View

18.

Lee U, Kim C, Chung C, Choi Y, Yang S, Park S . The Recovery of Motor Strength after Posterior Percutaneous Endoscopic Cervical Foraminotomy and Discectomy. World Neurosurg. 2018; 115:e532-e538. DOI: 10.1016/j.wneu.2018.04.090. View

19.

Balasubramanian C, Price R, Brydon H . Anterior cervical microforaminotomy for cervical radiculopathy--results and review. Minim Invasive Neurosurg. 2008; 51(5):258-62. DOI: 10.1055/s-0028-1082320. View

20.

Davis R . A long-term outcome study of 170 surgically treated patients with compressive cervical radiculopathy. Surg Neurol. 1996; 46(6):523-30; discussion 530-3. DOI: 10.1016/s0090-3019(96)00278-9. View