What's the best surgical treatment for patients with cervical radiculopathy due to single-level degenerative disease? A randomized controlled trial

• Published in: PloS one Vol. 12; no. 8; p. e0183603
• Main Authors: Donk, Roland D, Verbeek, André L M, Verhagen, Wim I M, Groenewoud, Hans, Hosman, Allard J F, Bartels, Ronald H M A
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 29.08.2017; Public Library of Science (PLoS)
• Subjects: Adolescent; Adult; Arthroplasty; Biology and Life Sciences; Biomedical materials; Bone surgery; Cages; Cervical Vertebrae - surgery; Clinical trials; Compression; Control methods; Degeneration; Disability Evaluation; Disease control; Female; Follow-Up Studies; Hospitals; Humans; Inspection; Intervertebral Disc Degeneration - complications; Intervertebral Disc Degeneration - surgery; Intervertebral discs; Joint surgery; Male; Medical research; Medicine and Health Sciences; Middle Aged; Neck; Neurosurgery; Nondestructive testing; Orthopedics; Pain; Patients; People and Places; Prostheses; Radiculopathy - etiology; Radiculopathy - surgery; Research and Analysis Methods; Spinal Fusion - adverse effects; Spinal Fusion - methods; Studies; Surgery; Surgical implants; Surgical outcomes; Total Disc Replacement - adverse effects; Total Disc Replacement - methods; Transplants & implants; Treatment Outcome; Urinary tract infections; Young Adult; Netherlands
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0183603

To investigate the efficacy of adding supplemental fusion or arthroplasty after cervical anterior discectomy for symptomatic mono-level cervical degenerative disease (radiculopathy), which has not been substantiated in controlled trials until now. A randomized controlled trial is reported with 9 years follow up comparing anterior cervical anterior discectomy without fusion, with fusion by cage standalone, or with disc prosthesis. Patients suffering from symptomatic cervical disk degeneration at one level referred to spinal sections of department of neurosurgery or orthopedic surgery of a large general hospital with educational facilities were eligible. Neck Disability Index (NDI), McGill Pain Questionnaire Dutch language version (MPQ-DLV), physical-component summary (PCS), and mental-component summary (MCS) of the 36-item Short-Form Health Survey (SF-36), and re operation rate were evaluated. 142 patients between 18 and 55 years were allocated. The median follow-up was 8.9±1.9 years (5.6 to 12.2 years). The response rate at last follow-up was 98.5%. NDI at the last follow-up did not differ between the three treatment groups, nor did the secondary outcomes as MPQ-DLV and PCS or MCS from SF-36. The major improvement occurred within the first 6 weeks after surgery. Afterward, it remained stable. Eleven patients underwent surgery for recurrent symptoms and signs due to nerve root compression at the index or adjacent level. This randomized trial could not detect a difference between three surgical modalities for treating a single-level degenerative disk disease. Anterior cervical discectomy without implant seems to be similar to anterior cervical discectomy with fusion by cage stand-alone or with disk prosthesis. Due to the small study sample size, this statement should be considered as inconclusive so far. ISRCTN41681847.