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

被引:38
作者
Donk, Roland D. [1 ]
Verbeek, Andre L. M. [2 ]
Verhagen, Wim I. M. [3 ]
Groenewoud, Hans [2 ]
Hosman, Allard J. F. [4 ]
Bartels, Ronald H. M. A. [5 ,6 ]
机构
[1] Via Sana Clin, Dept Orthoped Surg, Mill, Netherlands
[2] Radboud Univ Nijmegen, Med Ctr, Dept Hlth Evidence, Nijmegen, Netherlands
[3] Canisius Wilhelmina Hosp, Dept Neurol, Nijmegen, Netherlands
[4] Radboud Univ Nijmegen, Med Ctr, Dept Orthoped Surg, Nijmegen, Netherlands
[5] Radboud Univ Nijmegen, Med Ctr, Dept Neurosurg, Nijmegen, Netherlands
[6] Canisius Wilhelmina Hosp, Dept Neurosurg, Nijmegen, Netherlands
关键词
NECK-DISABILITY-INDEX; DISC ARTHROPLASTY; FUSION; EPIDEMIOLOGY; PAIN; METAANALYSIS; DISKECTOMY; QUALITY;
D O I
10.1371/journal.pone.0183603
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Background 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. Methods 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. Findings 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. Conclusions 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.
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页数:17
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