Systematic reviews related to this topic

loading
10 References (10 articles) loading Revert Studify

Systematic review

Unclassified

The course and prognostic factors of symptomatic cervical disc herniation with radiculopathy: a systematic review of the literature.

blocked
Journal The spine journal : official journal of the North American Spine Society
Year 2014
Links Pubmed DOI

This article includes 3 Primary studies 3 Primary studies (3 references)

Loading references information
BACKGROUND CONTEXT: Cervical spine disc herniation is a disabling source of cervical radiculopathy. However, little is known about its course and prognosis. Understanding the course and prognosis of symptomatic cervical disc herniation is necessary to guide patients' expectations and assist clinicians in managing patients. PURPOSE: To describe the natural history, clinical course, and prognostic factors of symptomatic cervical disc herniations with radiculopathy. STUDY DESIGN: Systematic review of the literature and best evidence synthesis. METHODS: A systematic search of MEDLINE, EMBASE, CINAHL, SportsDiscus, and the Cochrane Central Register of Controlled Trials from inception to 2013 was conducted to retrieve eligible articles. Eligible articles were critically appraised using the Scottish Intercollegiate Guidelines Network criteria. The results from articles with low risk of bias were analyzed using best evidence synthesis principles. RESULTS: We identified 1,221 articles. Of those, eight articles were eligible and three were accepted as having a low risk of bias. Two studies pertained to course and one study pertained to prognosis. Most patients with symptomatic cervical disc herniations with radiculopathy initially present with intense pain and moderate levels of disability. However, substantial improvements tend to occur within the first 4 to 6 months post-onset. Time to complete recovery ranged from 24 to 36 months in, approximately, 83% of patients. Patients with a workers' compensation claim appeared to have a poorer prognosis. CONCLUSIONS: Our best evidence synthesis describes the best available evidence on the course and prognosis of cervical disc herniations with radiculopathy. Most patients with symptomatic cervical spine disc herniation with radiculopathy recover. Possible recurrences and time to complete recovery need to be further studied. More studies are also needed to understand the prognostic factors for this condition.

Systematic review

Unclassified

A systematic review of RCTs with nucleoplasty - an update.

Journal Pain physician
Year 2013
Links Pubmed

This article includes 6 Primary studies 6 Primary studies (6 references)

Loading references information

Systematic review

Unclassified

Surgery versus conservative care for neck pain: a systematic review.

Journal European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
Year 2013
Links Pubmed DOI PubMed Central

This article includes 9 Primary studies 9 Primary studies (9 references)

Loading references information
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 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.

Systematic review

Unclassified

Effectiveness of therapeutic lumbar transforaminal epidural steroid injections in managing lumbar spinal pain.

Journal Pain physician
Year 2012
Links Pubmed

This article is included in 1 Structured summary of systematic reviews 25 Structured summaries of systematic reviews (1 reference) 1 Broad synthesis 25 Broad syntheses (1 reference)

This article includes 27 Primary studies 25 Primary studies (27 references)

Loading references information
BACKGROUND: Among the multiple interventions used in managing chronic spinal pain, lumbar epidural injections have been used extensively to treat lumbar radicular pain. Among caudal, interlaminar, and transforaminal, transforaminal epidural injections have gained rapid and widespread acceptance for the treatment of lumbar and lower extremity pain. The potential advantages of transforaminal over interlaminar and caudal, include targeted delivery of a steroid to the site of pathology, presumably onto an inflamed nerve root. However, there are only a few well-designed, randomized, controlled studies on the effectiveness of steroid injections. Consequently, multiple systematic reviews with diverse opinions have been published. STUDY DESIGN: A systematic review of therapeutic transforaminal epidural injection therapy for low back and lower extremity pain. OBJECTIVE: To evaluate the effect of therapeutic transforaminal lumbar epidural steroid injections in managing low back and lower extremity pain. METHODS: The available literature on lumbar transforaminal epidural injections in managing chronic low back and lower extremity pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and by the Newcastle-Ottawa Scale criteria for observational studies. Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to December 2011, and manual searches of the bibliographies of known primary and review articles. The level of evidence was classified as good, fair, or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). OUTCOME MEASURES: The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake. RESULTS: For this systematic review, 70 studies were identified. Of these, 43 studies were excluded and a total of 27 studies met inclusion criteria for methodological quality assessment with 15 randomized trials (with 2 duplicate publications) and 10 non-randomized studies. For lumbar disc herniation, the evidence is good for transforaminal epidural with local anesthetic and steroids, whereas it was fair for local anesthetics alone and the ability of transforaminal epidural injections to prevent surgery. For spinal stenosis, the available evidence is fair for local anesthetic and steroids. The evidence for axial low back pain and post lumbar surgery syndrome is poor, inadequate, limited, or unavailable. LIMITATIONS: The limitations of this systematic review include the paucity of literature. CONCLUSION: In summary, the evidence is good for radiculitis secondary to disc herniation with local anesthetics and steroids and fair with local anesthetic only; it is fair for radiculitis secondary to spinal stenosis with local anesthetic and steroids; and limited for axial pain and post surgery syndrome using local anesthetic with or without steroids.

Systematic review

Unclassified

Evaluation of treatment effectiveness for the herniated cervical disc: a systematic review.

Journal Spine
Year 2012
Links Pubmed DOI

This article includes 11 Primary studies 11 Primary studies (11 references)

Loading references information
STUDY DESIGN.: Systematic review. OBJECTIVE.: To assess the effectiveness of interventions for treating cervical disc herniation. SUMMARY OF BACKGROUND DATA.: Cervical disc herniation is 1 of the 23 specific disorders included in the CANS (Complaints of the Arm, Neck, and/or Shoulder) model. Treatment options range from conservative to surgical, but evidence for the effectiveness of these interventions is not yet well documented. METHODS.: The Cochrane Library, MEDLINE, EMBASE, PEDro, and CINAHL were searched for relevant systematic reviews and randomized clinical trials (RCTs) up to February 2009. Two reviewers independently selected relevant studies, assessed the methodological quality, and extracted data. RESULTS.: Pooling of the data was not possible; thus, a best-evidence synthesis was used to summarize the results. Of the 11 RCTs included, 1 compared conservative with surgical intervention, and 10 compared various surgical interventions. No evidence was found for the effectiveness of conservative treatment (nonsteroidal anti-inflammatory drugs, cortisonics, and physical therapy) compared with percutaneous nucleoplasty. Moderate evidence was found for the effectiveness of anterior cervical discectomy with fusion (ACDF) using a titanium cage compared with ACDF using polymethyl methacrylate, and for BRYAN cervical disc (Medtronic Sofamor Danek, Memphis, TN) prostheses compared with ACDF using allograft bone and plating. No outcomes regarding adjacent-level disease were reported. There is conflicting evidence for the effectiveness of ACD compared with ACDF. Only limited or no evidence was found for the other surgical interventions. CONCLUSION.: No evidence for effectiveness of conservative treatment compared with surgery was found. Although there is moderate evidence for the effectiveness of some surgical interventions, no unequivocal evidence for the superiority of 1 particular surgical treatment was found. Worldwide, most patients receive supplementary implants; however, cervical discectomy without graft may be preferred because of similar outcomes, lower costs, and possibly a lower risk of adjacent-level disease. More high-quality RCTs using validated outcome measures (including adjacent level disease) are needed.

Systematic review

Unclassified

Effectiveness of manual physical therapy in the treatment of cervical radiculopathy: A systematic review

blocked
Authors Boyles R , Toy P , Mellon J , Hayes M , Hammer B
Journal The Journal of manual & manipulative therapy
Year 2011
Links Pubmed DOI PubMed Central

This article includes 4 Primary studies 4 Primary studies (4 references)

Loading references information
Study design: Systematic review of randomized clinical trials. Objective: Review of current literature regarding the effectiveness of manual therapy in the treatment of cervical radiculopathy. Background: Cervical radiculopathy (CR) is a clinical condition frequently encountered in the physical therapy clinic. Cervical radiculopathy is a result of space occupying lesions in the cervical spine: either cervical disc herniations, spondylosis, or osteophytosis. These affect the pain generators of bony and ligamentous tissues, producing radicular symptoms (i.e. pain, numbness, weakness, paresthesia) observed in the upper extremity of patients with cervical nerve root pathology. Cervical radiculopathy has a reported annual incidence of 83.2 per 100 000 and an increased prevalence in the fifth decade of life among the general population. Results: Medline and CINAHL via EBSCO, Cochrane Library, and Google Scholar were used to retrieve the randomized clinical trial studies for this review between the years of 1995 and February of 2011. Four studies met inclusion criteria and were considered to be high quality (PEDro scores of >5). Manual therapy techniques included muscle energy techniques, non-thrust/thrust manipulation/mobilization of the cervical and/or thoracic spine, soft-tissue mobilization, and neural mobilization. In each study, manual therapy was either a stand-alone intervention or part of a multimodal approach which included therapeutic exercise and often some form of cervical traction. Although no clear cause and effect relationship can be established between improvement in radicular symptoms and manual therapy, results are generally promising. Conclusion: Although a definitive treatment progression for treating CR has not been developed a general consensus exists within the literature that using manual therapy techniques in conjunction with therapeutic exercise is effective in regard to increasing function, as well as AROM, while decreasing levels of pain and disability. High quality RCTs featuring control groups are necessary to establish clear and effective protocols in the treatment of CR. © W. S. Maney & Son Ltd 2011.

Systematic review

Unclassified

Surgery for cervical radiculopathy or myelopathy.

blocked
Journal Cochrane database of systematic reviews (Online)
Year 2010
Links Pubmed DOI PubMed Central

This article is included in 2 Broad syntheses 6 Broad syntheses (2 references)

This article includes 9 Primary studies 6 Primary studies (9 references)

Loading references information
BACKGROUND: Cervical spondylosis causes pain and disability by compressing the spinal cord or roots. Surgery to relieve the compression may reduce the pain and disability, but is associated with a small but definite risk. . OBJECTIVES: To determine whether: 1) surgical treatment of cervical radiculopathy or myelopathy is associated with improved outcome, compared with conservative management and 2) timing of surgery (immediate or delayed pending persistence/progression of relevant symptoms and signs) has an impact on outcome. SEARCH STRATEGY: We searched CENTRAL, MEDLINE, and EMBASE to 1998 for the original review. A revised search was run in CENTRAL (The Cochrane Library 2008, Issue 2), MEDLINE, EMBASE, and CINAHL (January 1998 to June 2008) to update the review.Authors of the identified randomised controlled trials were contacted for additional published or unpublished data. SELECTION CRITERIA: All randomised or quasi-randomised controlled trials allocating patients with cervical radiculopathy or myelopathy to 1) "medical management" or "decompressive surgery (with or without fusion) plus medical management" 2) "early decompressive surgery" or "delayed decompressive surgery". DATA COLLECTION AND ANALYSIS: Two authors independently selected trials, assessed risk of bias and extracted data. MAIN RESULTS: Two trials (N = 149) were included. In both trials, allocation concealment was inadequate and arrangements for blinding of outcome assessment were unclear.One trial (81 patients with cervical radiculopathy) found that surgical decompression was superior to physiotherapy or cervical collar immobilization in the short-term for pain, weakness or sensory loss; at one year, there were no significant differences between groups.One trial (68 patients with mild functional deficit associated with cervical myelopathy) found no significant differences between surgery and conservative treatment in three years following treatment. A substantial proportion of cases were lost to follow-up. AUTHORS' CONCLUSIONS: Both small trials had significant risks of bias and do not provide reliable evidence on the effects of surgery for cervical spondylotic radiculopathy or myelopathy. It is unclear whether the short-term risks of surgery are offset by long-term benefits. Further research is very likely to have an impact on the estimate of effect and our confidence in it.There is low quality evidence that surgery may provide pain relief faster than physiotherapy or hard collar immobilization in patients with cervical radiculopathy; but there is little or no difference in the long-term.There is very low quality evidence that patients with mild myelopathy feel subjectively better shortly after surgery, but there is little or no difference in the long-term.

Systematic review

Unclassified

Manual therapy and exercise for neck pain: a systematic review.

Journal Manual therapy
Year 2010
Links Pubmed DOI

This article is included in 1 Structured summary of systematic reviews 20 Structured summaries of systematic reviews (1 reference) 1 Broad synthesis 20 Broad syntheses (1 reference)

This article includes 27 Primary studies 20 Primary studies (27 references)

Loading references information
Manual therapy is often used with exercise to treat neck pain. This cervical overview group systematic review update assesses if manual therapy, including manipulation or mobilisation, combined with exercise improves pain, function/disability, quality of life, global perceived effect, and patient satisfaction for adults with neck pain with or without cervicogenic headache or radiculopathy. Computerized searches were performed to July 2009. Two or more authors independently selected studies, abstracted data, and assessed methodological quality. Pooled relative risk (pRR) and standardized mean differences (pSMD) were calculated. Of 17 randomized controlled trials included, 29% had a low risk of bias. Low quality evidence suggests clinically important long-term improvements in pain (pSMD-0.87(95% CI: -1.69, -0.06)), function/disability, and global perceived effect when manual therapy and exercise are compared to no treatment. High quality evidence suggests greater short-term pain relief [pSMD-0.50(95% CI: -0.76, -0.24)] than exercise alone, but no long-term differences across multiple outcomes for (sub)acute/chronic neck pain with or without cervicogenic headache. Moderate quality evidence supports this treatment combination for pain reduction and improved quality of life over manual therapy alone for chronic neck pain; and suggests greater short-term pain reduction when compared to traditional care for acute whiplash. Evidence regarding radiculopathy was sparse. Specific research recommendations are made.

Systematic review

Unclassified

Neurologic outcome of surgical and conservative treatment of rheumatoid cervical spine subluxation: A systematic review

Journal Arthritis and rheumatism
Year 2009
Links Pubmed DOI

This article is included in 1 Structured summary of systematic reviews 25 Structured summaries of systematic reviews (1 reference)

This article includes 26 Primary studies 25 Primary studies (26 references)

Loading references information
Objective. Rheumatoid arthritis commonly involves the upper cervical spine and can cause significant neurologic morbidity and mortality. However, there is no consensus on the optimal timing for surgical intervention: whether surgery should be performed prophylactically or once neurologic deficits have become apparent. Methods. A systematic review of the literature was performed to analyze neurologic outcome (Ranawat) and survival time (Kaplan-Meier) after surgical or conservative treatment using the MOOSE (Meta-analysis Of Observational Studies in Epidemiology) and GRADE (Grading of Recommendations, Assessment, Development and Evaluation system) criteria. Results. Twenty-five observational studies were selected. No randomized controlled trials (RCTs) could be found. All of the studies had a high risk of bias. Twenty-three studies reported the neurologic outcome after surgery for 752 patients. Neurologic deterioration rarely occurred in Ranawat I and II patients. Ranawat III patients did not fully recover. The 10-year survival rates were 77%, 63%, 47%, and 30% for Ranawat I, II, IIIA, and IIIB, respectively. The Ranawat IIIB patients had a significantly worse outcome. Another 185 patients treated conservatively were described in 7 studies. Neurologic deterioration rarely occurred in Ranawat I patients, but was almost inevitable in Ranawat II, IIIA, and IIIB patients. The Kaplan-Meier analysis showed a 10-year overall survival rate of 40%. Conclusion. There are no RCTs that compared surgery with conservative treatment. In observational studies, surgical neurologic outcomes were better than conservative treatment in all patients with cervical spine involvement, and in asymptomatic patients with no neurologic impairment (Ranawat I) the outcomes were similar; however, the evidence is weak. Survival time of surgical and conservative treatment could not be compared. © 2009, American College of Rheumatology.

Systematic review

Unclassified

A systematic literature review to identify the best method for a single level anterior cervical interbody fusion.

Journal European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
Year 2000
Links Pubmed DOI PubMed Central

This article is included in 1 Structured summary of systematic reviews 8 Structured summaries of systematic reviews (1 reference)

This article includes 8 Primary studies 8 Primary studies (8 references)

Loading references information
The goal of this systematic literature review was to determine, for patients with degenerative disc disease, which method of single-level anterior cervical interbody fusion using the anterior approach gives the best clinical and radiological outcome. The number of new techniques for obtaining a solid fusion has increased rapidly, but the rationale for choosing between different techniques is unclear. Randomised comparative studies on anterior cervical interbody fusions were identified in a sensitive Medline, Cochrane and Current Contents database search. Two independent reviewers evaluated the articles that met the selection criteria, using a checklist. The search yielded eight randomised, controlled trials for the systematic literature review. Three of these studies were judged to be of sufficient quality with regard to methodology and the information provided. In the three articles, five different treatment methods were investigated, four of which were interbody fusions. Fusion rates varied between 28% for an allograft method and 63% for a discectomy-alone method. In one study, kyphosis varied from 40% to 62% between treatments. Good clinical outcome (disability, pain and symptoms) ratings varied from 66% to 82%. A meta-analysis to determine the best method for an anterior interbody fusion could not be performed due to the heterogeneity of the methods reported and because no standard outcome parameter was used. From this systematic literature review, a gold standard for the treatment of degenerative disc disease could not be identified.