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A 5-to 8-year randomized study on the treatment of cervical radiculopathy: anterior cervical decompression and fusion plus physiotherapy versus physiotherapy alone

Engquist, Markus, (författare)
Ryhov Hosp, Jönköping, Sweden.
Lofgren, Hakan, (författare)
Ryhov Hosp, Jönköping, Sweden.
Oberg, Birgitta, (författare)
Linköping Univ, Linköping, Sweden.
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Holtz, Anders, (författare)
Univ Uppsala Hosp, Uppsala, Sweden.
Peolsson, Anneli, (författare)
Linköping Univ, Linköping, Sweden.
Söderlund, Anne, (författare)
Mälardalens högskola, Hälsa och välfärd
Vavruch, Ludek, (författare)
Ryhov Hosp, Jönköping, Sweden.
Lind, Bengt, (författare)
Univ Gothenburg, Gothenburg, Sweden.
Löfgren, Håkan, (författare)
Ryhov Hospital, Sweden
Öberg, Birgitta, (författare)
Linköpings universitet, Avdelningen för fysioterapi, Linköpings universitet, Medicinska fakulteten
Soderlund, A. (författare)
Lifornia, V. P. (författare)
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Mälardalens högskola Akademin för hälsa, vård och välfärd. Hälsa och välfärd. (creator_code:org_t)
Linköpings universitet Institutionen för medicin och hälsa. Avdelningen för fysioterapi. (creator_code:org_t)
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Linköpings universitet Medicinska fakulteten. (creator_code:org_t)
Göteborgs universitet Sahlgrenska akademin. Institutionen för kliniska vetenskaper, sektionen för anestesi, biomaterial och ortopedi, Avdelningen för ortopedi. 
Uppsala universitet Medicinska och farmaceutiska vetenskapsområdet. Medicinska fakulteten. Institutionen för neurovetenskap. Neurokirurgi. (creator_code:org_t)
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2017
Engelska.
Ingår i: Journal of Neurosurgery-Spine. - 1547-5654. ; 26:1, s. 19-27
  • Tidskriftsartikel (refereegranskat)
Abstract Ämnesord
Stäng  
  • OBJECTIVE The aim of this study was to evaluate the 5- to 8-year outcome of anterior cervical decompression and fusion (ACDF) combined with a structured physiotherapy program as compared with that following the same physiotherapy program alone in patients with cervical radiculopathy. No previous prospective randomized studies with a follow-up of more than 2 years have compared outcomes of surgical versus nonsurgical intervention for cervical radiculopathy. METHODS Fifty-nine patients were randomized to ACDF surgery with postoperative physiotherapy (30 patients) or to structured physiotherapy alone (29 patients). The physiotherapy program included general and specific exercises as well as pain coping strategies. Outcome measures included neck disability (Neck Disability Index [NDI]), neck and arm pain intensity (visual analog scale [VAS]), health state (EQ-5D questionnaire), and a patient global assessment. Patients were followed up for 5-8 years. RESULTS After 5-8 years, the NDI was reduced by a mean score% of 21 (95% CI 14-28) in the surgical group and 11% (95% CI 4%-18%) in the nonsurgical group (p = 0.03). Neck pain was reduced by a mean score of 39 mm (95% CI 26-53 mm) compared with 19 mm (95% CI 7-30 mm; p = 0.01), and arm pain was reduced by a mean score of 33 mm (95% CI 18-49 mm) compared with 19 mm (95% CI 7-32 mm; p = 0.1), respectively. The EQ-5D had a mean respective increase of 0.29 (95% CI 0.13-0.45) compared with 0.14 (95% CI 0.01-0.27; p = 0.12). Ninety-three percent of patients in the surgical group rated their symptoms as "better" or "much better" compared with 62% in the nonsurgical group (p = 0.005). Both treatment groups experienced significant improvement over baseline for all outcome measures. CONCLUSIONS In this prospective randomized study of 5- to 8-year outcomes of surgical versus nonsurgical treatment in patients with cervical radiculopathy, ACDF combined with physiotherapy reduced neck disability and neck pain more effectively than physiotherapy alone. Self-rating by patients as regards treatment outcome was also superior in the surgery group. No significant differences were seen between the 2 patient groups as regards arm pain and health outcome.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskaper -- Sjukgymnastik (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Health Sciences -- Physiotherapy (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP  (hsv//swe)
MEDICAL AND HEALTH SCIENCES  (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Ortopedi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Orthopedics (hsv//eng)

Nyckelord

cervical radiculopathy
randomized
surgery
physiotherapy
anterior cervical decompression and fusion
outcome
cervical radiculopathy; randomized; surgery; physiotherapy; anterior cervical decompression and fusion; outcome
anterior cervical decompression and
neck-disability-index
interbody fusion
disc disease
follow-up
nonsurgical treatment
diskectomy
reliability
myelopathy
validity
Neurosciences & Neurology
Surgery

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