Cervical Radiculopathy. Effects of Surgery, Physiotherapy or Cervical Collar. A prospective, randomised study

Abstract: The efficacy of surgery, physiotherapy or a cervical collar in the treatment of chronic cervicobrachial pain of radicular origin was evaluated in a prospective, randomised study comprising 81 patients of both sexes, 28-64 years of age, referred for possible neurosurgical treatment. After neurological and radiological examination and giving their informed consent, they were randomised to one of the three treatments. The surgery group underwent anterior decompression and single level fusion by bovine graft. The conservatively treated groups received individual physiotherapy or a rigid cervical collar for three months. The effects were evaluated at three months and 12 months later with respect to pain, tender points, sensory disturbance, muscle strength, neck and shoulder joint mobility, postural control, mood and health status. All treated groups improved, although the improvement rate differed. The surgically treated group was significantly better at three months, but one year later, there was no significant difference between the three groups. The studies variables also included the patients? balance in comparison with a healthy control group and the occurrence of headache. Before treatment, the patients manifested significantly poorer postural control than sex and age- matched controls. Three months after treatment the surgery group showed a significantly improved postural performance and the collar group showed the poorest. Forty-nine of the 81 patients were classified as having cervical headache and 24 of these reported that their headache had improved at the three months? control. Patients with cervical headache reported significantly more cervicobrachial pain and higher tenderness score than patients with cervical radiculopathy with no headache. No one-year follow-up was performed concerning balance and headache. It may be concluded that pain intensity, sensory disturbance, muscle strength and health status can be expected to improve most rapidly after surgery, but a slow improvement with conservative treatments makes the one-year results about equal.