Indications for anterior cervical decompression for the treatment of cervical degenerative radiculopathy

Paul G. Matz, Langston T. Holly, Michael W. Groff, Edward J. Vresilovic, Paul A. Anderson, Robert F. Heary, Michael G. Kaiser, Praveen V. Mummaneni, Timothy C. Ryken, Tanvir F. Choudhri, Daniel K. Resnick

Research output: Contribution to journalReview article

39 Citations (Scopus)

Abstract

Object. The objective of this systematic review was to use evidence-based medicine to identify the indications and utility of anterior cervical nerve root decompression. Methods. The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to surgical management of cervical radiculopathy. Abstracts were reviewed after which studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I-III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results. Anterior nerve root decompression via anterior cervical discectomy (ACD) with or without fusion for radiculopathy is associated with rapid relief (3-4 months) of arm/neck pain, weakness, and/or sensory loss compared with physical therapy (PT) or cervical collar immobilization. Anterior cervical discectomy and ACD with fusion (ACDF) are associated with longer term (12 months) improvement in certain motor functions compared to PT. Other rapid gains observed after anterior decompression (diminished pain, improved sensation, and improved strength in certain muscle groups) are also maintained over the course of 12 months. However, comparable clinical improvements with PT or cervical immobilization therapy are also present in these clinical modalities (Class I). Conflicting evidence exists as to the efficacy of anterior cervical foraminotomy with reported success rates of 52-99% but recurrent symptoms as high as 30% (Class III). Conclusions. Anterior cervical discectomy, ACDF, and anterior cervical foraminotomy may improve cervical radicular symptoms. With regard to ACD and ACDF compared to PT or cervical immobilization, more rapid relief (within 3-4 months) may be seen with ACD or ACDF with maintenance of gains over the course of 12 months (Class I). Anterior cervical foraminotomy is associated with improvement in clinical function but the quality of data are weaker (Class III), and there is a wide range of efficacy (52-99%).

Original languageEnglish (US)
Pages (from-to)174-182
Number of pages9
JournalJournal of Neurosurgery: Spine
Volume11
Issue number2
DOIs
StatePublished - Aug 1 2009

Fingerprint

Diskectomy
Radiculopathy
Decompression
Foraminotomy
Immobilization
Guidelines
Somatosensory Disorders
Therapeutics
Medical Subject Headings
National Library of Medicine (U.S.)
Peer Review
Neck Pain
Evidence-Based Medicine
Consensus
Joints
Maintenance
Databases
Muscles

All Science Journal Classification (ASJC) codes

  • Surgery
  • Neurology
  • Clinical Neurology

Cite this

Matz, P. G., Holly, L. T., Groff, M. W., Vresilovic, E. J., Anderson, P. A., Heary, R. F., ... Resnick, D. K. (2009). Indications for anterior cervical decompression for the treatment of cervical degenerative radiculopathy. Journal of Neurosurgery: Spine, 11(2), 174-182. https://doi.org/10.3171/2009.3.SPINE08720
Matz, Paul G. ; Holly, Langston T. ; Groff, Michael W. ; Vresilovic, Edward J. ; Anderson, Paul A. ; Heary, Robert F. ; Kaiser, Michael G. ; Mummaneni, Praveen V. ; Ryken, Timothy C. ; Choudhri, Tanvir F. ; Resnick, Daniel K. / Indications for anterior cervical decompression for the treatment of cervical degenerative radiculopathy. In: Journal of Neurosurgery: Spine. 2009 ; Vol. 11, No. 2. pp. 174-182.
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abstract = "Object. The objective of this systematic review was to use evidence-based medicine to identify the indications and utility of anterior cervical nerve root decompression. Methods. The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to surgical management of cervical radiculopathy. Abstracts were reviewed after which studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I-III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results. Anterior nerve root decompression via anterior cervical discectomy (ACD) with or without fusion for radiculopathy is associated with rapid relief (3-4 months) of arm/neck pain, weakness, and/or sensory loss compared with physical therapy (PT) or cervical collar immobilization. Anterior cervical discectomy and ACD with fusion (ACDF) are associated with longer term (12 months) improvement in certain motor functions compared to PT. Other rapid gains observed after anterior decompression (diminished pain, improved sensation, and improved strength in certain muscle groups) are also maintained over the course of 12 months. However, comparable clinical improvements with PT or cervical immobilization therapy are also present in these clinical modalities (Class I). Conflicting evidence exists as to the efficacy of anterior cervical foraminotomy with reported success rates of 52-99{\%} but recurrent symptoms as high as 30{\%} (Class III). Conclusions. Anterior cervical discectomy, ACDF, and anterior cervical foraminotomy may improve cervical radicular symptoms. With regard to ACD and ACDF compared to PT or cervical immobilization, more rapid relief (within 3-4 months) may be seen with ACD or ACDF with maintenance of gains over the course of 12 months (Class I). Anterior cervical foraminotomy is associated with improvement in clinical function but the quality of data are weaker (Class III), and there is a wide range of efficacy (52-99{\%}).",
author = "Matz, {Paul G.} and Holly, {Langston T.} and Groff, {Michael W.} and Vresilovic, {Edward J.} and Anderson, {Paul A.} and Heary, {Robert F.} and Kaiser, {Michael G.} and Mummaneni, {Praveen V.} and Ryken, {Timothy C.} and Choudhri, {Tanvir F.} and Resnick, {Daniel K.}",
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Matz, PG, Holly, LT, Groff, MW, Vresilovic, EJ, Anderson, PA, Heary, RF, Kaiser, MG, Mummaneni, PV, Ryken, TC, Choudhri, TF & Resnick, DK 2009, 'Indications for anterior cervical decompression for the treatment of cervical degenerative radiculopathy', Journal of Neurosurgery: Spine, vol. 11, no. 2, pp. 174-182. https://doi.org/10.3171/2009.3.SPINE08720

Indications for anterior cervical decompression for the treatment of cervical degenerative radiculopathy. / Matz, Paul G.; Holly, Langston T.; Groff, Michael W.; Vresilovic, Edward J.; Anderson, Paul A.; Heary, Robert F.; Kaiser, Michael G.; Mummaneni, Praveen V.; Ryken, Timothy C.; Choudhri, Tanvir F.; Resnick, Daniel K.

In: Journal of Neurosurgery: Spine, Vol. 11, No. 2, 01.08.2009, p. 174-182.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Indications for anterior cervical decompression for the treatment of cervical degenerative radiculopathy

AU - Matz, Paul G.

AU - Holly, Langston T.

AU - Groff, Michael W.

AU - Vresilovic, Edward J.

AU - Anderson, Paul A.

AU - Heary, Robert F.

AU - Kaiser, Michael G.

AU - Mummaneni, Praveen V.

AU - Ryken, Timothy C.

AU - Choudhri, Tanvir F.

AU - Resnick, Daniel K.

PY - 2009/8/1

Y1 - 2009/8/1

N2 - Object. The objective of this systematic review was to use evidence-based medicine to identify the indications and utility of anterior cervical nerve root decompression. Methods. The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to surgical management of cervical radiculopathy. Abstracts were reviewed after which studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I-III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results. Anterior nerve root decompression via anterior cervical discectomy (ACD) with or without fusion for radiculopathy is associated with rapid relief (3-4 months) of arm/neck pain, weakness, and/or sensory loss compared with physical therapy (PT) or cervical collar immobilization. Anterior cervical discectomy and ACD with fusion (ACDF) are associated with longer term (12 months) improvement in certain motor functions compared to PT. Other rapid gains observed after anterior decompression (diminished pain, improved sensation, and improved strength in certain muscle groups) are also maintained over the course of 12 months. However, comparable clinical improvements with PT or cervical immobilization therapy are also present in these clinical modalities (Class I). Conflicting evidence exists as to the efficacy of anterior cervical foraminotomy with reported success rates of 52-99% but recurrent symptoms as high as 30% (Class III). Conclusions. Anterior cervical discectomy, ACDF, and anterior cervical foraminotomy may improve cervical radicular symptoms. With regard to ACD and ACDF compared to PT or cervical immobilization, more rapid relief (within 3-4 months) may be seen with ACD or ACDF with maintenance of gains over the course of 12 months (Class I). Anterior cervical foraminotomy is associated with improvement in clinical function but the quality of data are weaker (Class III), and there is a wide range of efficacy (52-99%).

AB - Object. The objective of this systematic review was to use evidence-based medicine to identify the indications and utility of anterior cervical nerve root decompression. Methods. The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to surgical management of cervical radiculopathy. Abstracts were reviewed after which studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I-III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results. Anterior nerve root decompression via anterior cervical discectomy (ACD) with or without fusion for radiculopathy is associated with rapid relief (3-4 months) of arm/neck pain, weakness, and/or sensory loss compared with physical therapy (PT) or cervical collar immobilization. Anterior cervical discectomy and ACD with fusion (ACDF) are associated with longer term (12 months) improvement in certain motor functions compared to PT. Other rapid gains observed after anterior decompression (diminished pain, improved sensation, and improved strength in certain muscle groups) are also maintained over the course of 12 months. However, comparable clinical improvements with PT or cervical immobilization therapy are also present in these clinical modalities (Class I). Conflicting evidence exists as to the efficacy of anterior cervical foraminotomy with reported success rates of 52-99% but recurrent symptoms as high as 30% (Class III). Conclusions. Anterior cervical discectomy, ACDF, and anterior cervical foraminotomy may improve cervical radicular symptoms. With regard to ACD and ACDF compared to PT or cervical immobilization, more rapid relief (within 3-4 months) may be seen with ACD or ACDF with maintenance of gains over the course of 12 months (Class I). Anterior cervical foraminotomy is associated with improvement in clinical function but the quality of data are weaker (Class III), and there is a wide range of efficacy (52-99%).

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