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Evidence for Neurosurgery pp 175–191Cite as

Early Versus Delayed Surgery for Cervical Disc Herniation

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Abstract

Background: Cervical radiculopathy due to disc herniation is a menace both to quality of life and the labor force. Early surgical treatment allows early rehabilitation but is associated with surgical complication risks. Delayed treatment allows many patients to recover with physiotherapy, without affecting the surgical wait list, but late return to work and delayed crossover into surgical treatment may become costly for society.

Objectives: The main goal of this review was to investigate whether the timing of surgery has an impact on clinical outcomes in patients with cervical radiculopathy.

Search Methods: An electronic search for randomized controlled trials published between January 1st, 2000 and December 31st, 2017 was carried out, using following databases:

NLM PubMed MEDLINE, Google Scholar, Cochrane Library and ClinicalTrials.gov.

Selection Criteria: Only randomized controlled trials on treatment of acute cervical radiculopathy were included for further analysis. Studies that did not contain information regarding surgical treatment of cervical radiculopathy and those with more than 10% pediatric patients (<18 years of age) or more than 10% elderly patients (≥65 years of age), were excluded.

Data Collection and Analysis: Of the initial 564 studies, only two underwent qualitative synthesis and only one study, with 58 study participants, could be included in the meta-analysis. Included in the meta-analysis were: neck and arm pain (VAS, range 0–10) and the Neck Disability Index (NDI, range 0–100), presented with mean difference (MD) with a 95% confidence interval (95% CI).

Main Results: The current evidence supports the conclusion that early surgery (within 6 months) contributes to a better outcome with regard to arm pain (p = 0.04, MD −1.4, 95% CI −2.74 to −0.06). There is a trend towards better neck functioning (NDI) after early surgical intervention (p = 0.06, MD −4.80, 95% CI −24.36 to 14.76). No effect of timing on neck pain was seen (p = 0.3, MD −0.9, 95% CI −2.76 to 0.06).

Authors’ Conclusions: There is only weak evidence supporting the conclusion that surgical treatment should be performed within 6 months after debut of radiculopathy because it corresponds with better clinical outcome with regard to arm pain. This finding should therefore be validated by randomized controlled trials, using timing as a comparator.

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Author information

Authors and Affiliations

  1. Spine Unit, Department of Orthopaedics, Umeå University Hospital, Umeå, Sweden

    Lukas Bobinski

  2. Department of Orthopaedics, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden

    Yohan Robinson

Authors
  1. Lukas Bobinski
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Editor information

Editors and Affiliations

  1. Radboud University Medical Center, Nijmegen, The Netherlands

    Ronald H. M. A. Bartels

  2. Radboud University Medical Center, Nijmegen, The Netherlands

    Maroeska M. Rovers

  3. Radboud University Medical Center, Nijmegen, The Netherlands

    Gert P. Westert

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Bobinski, L., Robinson, Y. (2019). Early Versus Delayed Surgery for Cervical Disc Herniation. In: Bartels, R., Rovers, M., Westert, G. (eds) Evidence for Neurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-030-16323-5_12

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  • DOI: https://doi.org/10.1007/978-3-030-16323-5_12

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-16322-8

  • Online ISBN: 978-3-030-16323-5

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