Nonoperative Management is Associated With Similar Long-Term Patient-Reported Outcomes Compared With Surgery for Cervical Radiculopathy: A Systematic Review and Meta-analysis.
Kush M Kale, Yi Hein Chai, Shaan Patel et al.
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In 30 seconds
This systematic review and meta-analysis compared long-term patient-reported outcomes after surgical versus nonoperative management of cervical radiculopathy. It included 11 randomized and observational studies with 1154 patients (522 surgical; 632 nonoperative). At 12 months, surgery was not associated with significantly better arm pain, neck pain, or disability scores; overall clinical success was also similar (RR: 1.11, 95% CI: 0.93-1.34, P =0.21). The pooled findings describe outcomes in selected cohorts and do not establish that the strategies are therapeutically equivalent.
Key findings
- At 12 months, arm pain did not differ significantly between groups (MD: -0.67, 95% CI: -1.59 to 0.26, P =0.12).
- Neck pain (MD: -0.50, 95% CI: -1.38 to 0.38; P =0.19) and disability (NDI MD: -3.69, 95% CI: -9.63 to 2.25, P =0.16) were not significantly different at 12 months.
- Overall clinical success was not significantly different (RR: 1.11, 95% CI: 0.93-1.34, P =0.21); analgesia use and sick leave also showed no significant differences at last follow-up.
Why it matters
The pooled evidence suggests that long-term pain, disability, and functional outcomes may be comparable among patients selected for either management strategy. This helps frame discussions about expected longer-term outcomes, while underscoring that the findings do not show therapeutic equivalence or identify which individual patients benefit most from surgery.
What to keep in mind
Most included studies were rated at serious risk of bias, and the evidence combined randomized and observational studies. The authors caution that outcomes in selected cohorts should not be interpreted as therapeutic equivalence.