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

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  • Roland D Donk
  • André L M Verbeek
  • Wim I M Verhagen
  • Hans Groenewoud
  • Allard J F Hosman
  • Ronald H M A Bartels

Abstract

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. Trial registration: ISRCTN41681847

Suggested Citation

  • Roland D Donk & André L M Verbeek & Wim I M Verhagen & Hans Groenewoud & Allard J F Hosman & Ronald H M A Bartels, 2017. "What’s the best surgical treatment for patients with cervical radiculopathy due to single-level degenerative disease? A randomized controlled trial," PLOS ONE, Public Library of Science, vol. 12(8), pages 1-17, August.
    • Handle: RePEc:plo:pone00:0183603
    DOI: 10.1371/journal.pone.0183603
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    References listed on IDEAS

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    1. Kenneth F Schulz & Douglas G Altman & David Moher & for the CONSORT Group, 2010. "CONSORT 2010 Statement: Updated Guidelines for Reporting Parallel Group Randomised Trials," PLOS Medicine, Public Library of Science, vol. 7(3), pages 1-7, March.
    2. Roland Donk & Andre Verbeek & Wim Verhagen & Hans Groenewoud & Allard Hosman & Ronald Bartels, 2016. "The Qualification of Outcome after Cervical Spine Surgery by Patients Compared to the Neck Disability Index," PLOS ONE, Public Library of Science, vol. 11(8), pages 1-7, August.
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