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Factors affecting the outcome of surgical versus nonsurgical treatment of cervical radiculopathy: A randomized, controlled study
Ryhov Hospital, Jönköping, Sweden.
Ryhov Hospital, Jönköping, Sweden.
Linkoping University, Linköping, Sweden.
Uppsala University Hospital, Uppsala, Sweden.
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2015 (English)In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 40, no 20, 1553-1563 p.Article in journal (Refereed) Published
Abstract [en]

STUDY DESIGN: Prospective randomized controlled trial.

OBJECTIVE: To analyze factors that may influence the outcome of anterior cervical decompression and fusion (ACDF) followed by physiotherapy versus physiotherapy alone for treatment of patients with cervical radiculopathy.

SUMMARY OF BACKGROUND DATA: An understanding of patient-related factors affecting the outcome of ACDF is important for preoperative patient selection. No previous prospective, randomized study of treatment effect modifiers relating to outcome of ACDF compared with physiotherapy has been carried out.

METHODS: Sixty patients with cervical radiculopathy were randomized to ACDF followed by physiotherapy or physiotherapy alone. Data for possible modifiers of treatment outcome at one year, such as sex, age, duration of pain, pain intensity, disability (Neck Disability Index, NDI), patient expectations of treatment, anxiety due to neck/arm pain, distress (Distress And Risk Assessment Method, DRAM), self efficacy (Self Efficacy Scale, SES) health status (EQ-5D) and MRI findings were collected. A multivariate analysis was performed to find treatment effect modifiers affecting the outcome regarding arm/ neck pain intensity and NDI.

RESULTS: Factors that significantly altered the treatment effect between treatment groups in favor of surgery were: duration of neck pain < 12 months (p = 0.007), duration of arm pain < 12 months (p = 0.01) and female sex (p = 0.007) (outcome: arm pain), low EQ-5D index (outcome: neck pain, p = 0.02), high levels of anxiety due to neck/arm pain (outcome: neck pain, p = 0.02 and NDI, p = 0.02), low SES score (p = 0.05) and high DRAM score (p = 0.04). (outcome: NDI). No factors were found to be associated with better outcome with physiotherapy alone.

CONCLUSIONS: In this prospective, randomized study of patients with cervical radiculopathy, short duration of pain, female sex, low health quality, high levels of anxiety due to neck/arm pain, low self efficacy and a high level of distress before treatment were associated with better outcome from surgery. No factors were found to be associated with better outcome from physiotherapy alone.

Place, publisher, year, edition, pages
2015. Vol. 40, no 20, 1553-1563 p.
National Category
Orthopedics
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URN: urn:nbn:se:mdh:diva-30609DOI: 10.1097/BRS.0000000000001064ISI: 000369220500008PubMedID: 26192721Scopus ID: 2-s2.0-84950314113OAI: oai:DiVA.org:mdh-30609DiVA: diva2:889824
Available from: 2015-12-28 Created: 2015-12-28 Last updated: 2016-03-17Bibliographically approved

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