Surgery versus conservative care for neck pain: a systematic review
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REVIEW ARTICLE
Surgery versus conservative care for neck pain: a systematic review Marienke van Middelkoop • Sidney M. Rubinstein Raymond Ostelo • Maurits W. van Tulder • Wilco Peul • Bart W. Koes • Arianne P. Verhagen
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Received: 2 June 2012 / Revised: 30 August 2012 / Accepted: 10 October 2012 / Published online: 29 October 2012 Ó Springer-Verlag Berlin Heidelberg 2012
Abstract Objective General practitioners refer patients with continued neck pain that do not respond well to conservative care frequently to secondary care for further assessment. Are surgical interventions to the cervical spine effective when compared to conservative care for patients with neck pain? Design Systematic review. Method The search strategy outlined by the Cochrane Back Review Group (CBRG) was followed. The primary search was conducted in MEDLINE, EMBASE, CINAHL, CENTRAL, and PEDro up to June 2011. Randomised controlled trials (RCTs) and controlled clinical trials (CCTs) of adults with neck pain, which evaluated at least one clinically relevant primary outcome measure (e.g. pain, functional status, recovery), were included. In addition, treatments had to include surgery and conservative care. Two authors independently assessed risk of bias using the M. van Middelkoop B. W. Koes A. P. Verhagen (&) Department of General Practice, Erasmus MC, University Medical Center Rotterdam, PO BOX 2040, 3000 CA Rotterdam, The Netherlands e-mail: [email protected] S. M. Rubinstein R. Ostelo M. W. van Tulder Department of Epidemiology and Biostatistics, EMGO-Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands R. Ostelo M. W. van Tulder Department of Health Sciences, Faculty of Earth and Life Science and EMGO-Institute for Health and Care Research, VU University, Amsterdam, The Netherlands W. Peul Department of Neurosurgery, Leiden University Medical Center, Leiden, The Hague, The Netherlands
criteria recommended by the CBRG and extracted the data. The quality of the evidence was rated using the GRADE method. Results Patients included had neck pain with or without radiculopathy or myelopathy. In total, three RCTs and six CCTs were identified comparing different surgical interventions with conservative care, of which one had a low risk of bias. Overall there is very low quality of evidence available on the effectiveness of surgery compared to conservative care in neck pain patients showing overall no differences. Conclusion Most studies on surgical techniques comparing these to conservative care showed a high risk of bias. The benefit of surgery over conservative care is not clearly demonstrated. Keywords Systematic review Randomised controlled trials Surgery Conservative care
Introduction Cervical disorders are common and are frequently disabling and costly [1–4]. Cervical disorders can be classified into specific and non-specific disorders, such as cervical radiculopathy, discopathy and spondylosis. Typically, patients who are first managed in primary care end receive conservative t
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