Radiculopathy, Cervical

Sixty-five patients were enrolled (10–22 patients per site). Inclusion criteria included age 18–70 years, presence of diabetes mellitus, a sural nerve amplitude response of 1.0 µV or more and the presence of symmetrical distal DSP as defined by the modified San Antonio Criteria, in which two of symptoms, signs, abnormal nerve conduction parameters or abnormal vibration perception thresholds (VPT) were required [14 (link)]. Patients were stratified for disease severity on the basis of the TCNS in order to determine the performance of the mTCNS across the full range of disease severity [9 (link)]. Patients were excluded if they had known non-diabetic causes of neuropathy (for example, vitamin deficiencies, uraemia, thyroid disease, lumbar or cervical radiculopathy, inflammatory neuropathy or presence of alcoholism).

This study used a prospective longitudinal cohort design. Seventy-three patients with clinically and electrodiagnostically confirmed CTS were recruited from the surgical waiting lists at Oxford University Hospitals NHS Foundation Trust. Patients were excluded if electrodiagnostic testing revealed abnormalities other than CTS, if another medical condition affecting the upper limb and neck was present (e.g. hand osteoarthritis, cervical radiculopathy), if there was a history of significant trauma to the upper limb or neck, or if CTS was related to pregnancy or diabetes. Patients undergoing repeat carpal tunnel surgery were excluded. Whereas 60 patients underwent surgery and were included in the main cohort, 13 patients opted out of surgery after being consented, with the study team having no role in these patients’ decisions. While these patients were not the main focus of the study, we continued to follow them over time and report their data as a separate cohort. A cohort of 20 healthy volunteers (proportionally age- and gender-matched to the CTS surgery group) without any systemic medical condition, or a history of hand, arm or neck symptoms, served as healthy control subjects.
The study was approved by the London Riverside national research ethics committee (Ref 10/H0706/35), and all participants gave informed written consent in accordance with the Declaration of Helsinki. Whereas the healthy participants only attended a single session, all patients attended two appointments, one at baseline and a follow-up appointment (∼6 months after surgery/baseline appointment). In patients with CTS, the hand that was operated (surgery group) or the hand that was more affected (no-surgery group) was tested, whereas the non-dominant hand was tested in healthy controls. All clinical measurements were collected by the same experienced examiner to ensure consistency.

Two-hundred and two participants were consecutively recruited at four neurosurgery/neuro-orthopaedic clinics in Sweden between 2009 and 2012^{12 (link),13 (link)}, of which 201 underwent surgery (mean age 50; SD 8.4 years, 52% men, neck pain median duration 14 months; arm pain median duration 12 months; IQR 16). The inclusion criteria were: age 18–70 years, persistent radiculopathy symptoms for at least two months, clinical findings of nerve root compression based on examination by a neurosurgeon/neuro-orthopaedic surgeon and compatible with verified cervical disc disease determined by magnetic resonance imaging, and undergoing surgery for CR by either anterior approach (ACDF) or posterior approach with foraminotomy/laminectomy at one to three segmental levels. The exclusion criteria were: myelopathy, previous fracture or luxation of the cervical column, malignancy or spinal tumour, spinal infection, previous surgery in the cervical column, systematic disease or trauma that contraindicated either the rehabilitation programme or the measurements, diagnosis of a severe psychiatric disorder (such as schizophrenia or psychosis), known drug abuse and lack of familiarity with the Swedish language (unable to understand and answer the questionnaires). Of the 201 participants who underwent surgery, 163 were operated on with ACDF using standard cages (i.e. filled with bone substitute or autologous bone collected during decompression; no iliac crest graft was taken) at the clinic where the participant was included. In most cases of multilevel surgery, an anterior plate was added to achieve primary stability. Thirty-eight patients underwent posterior foraminotomy, with or without laminectomy (without fusion). Eight participants did not fulfil the clinical neurological examination at baseline and were excluded from this secondary analysis of outcomes. Thus, the present cohort consisted of 193 participants (Table 1). A total of 153 (79% response rate) and 135 (70% response rate) participants completed the clinical examination at one- and two-year follow-up (Fig. 1). Of the participants attending one-year follow-up, 83 (46%) were men and mean age was 50 (SD 8.2). At the two-year follow-up, 72 (53%) were men and mean age was 50 (SD 8.3). There was no difference in background variables or preoperative neurological outcomes between the patients who attended the neurological clinical examination at follow-up and those who were lost to follow-up (p > 0.194). Patients attending clinical examination at follow-up scored NDI mean value 21 (SD 16.7) at one-year follow-up, and 23 (SD 18.3) at two-year follow-up. There was also no difference in background variables or neurological outcomes at baseline between participants randomized to SPT or SA (p > 0.08) (Table 1).Table 1

Background variables for participants with cervical radiculopathy who underwent surgery and postoperative rehabilitation and were included in the secondary analysis of postoperative neurological outcomes.

	N	Total	SPT (N = 97)	SA (N = 96)
Age, mean (SD)	193	50 (8.4)	50 (8.3)	50 (8.6)
Sex male, n (%)	193	100 (52)	48 (50)	52 (54)
Anterior surgery, n (%)	193	155 (80)	73 (75)	82 (85)
NDI %, mean (SD)	184	43 (14.9)	42 (14.5)	44 (15.4)
Neck pain mm VAS, mean (SD)	188	56 (24.3)	55 (24.9)	57 (23.8)
Arm pain mm VAS, mean (SD)	185	50 (28.0)	52 (26.5)	48 (29.5)
Neurological impairment prick touch, n (%)	193	154 (80)	78 (80)	76 (80)
Neurological impairment light touch, n (%)	193	138 (72)	70 (72)	68 (71)
Neurological impairment motor function, n (%)	191	150 (79)	80 (83)	70 (74)
Neurological impairment arm reflex, n (%)	186	109 (59)	50 (53)	59 (64)
Positive Spurling test, n (%)	142	91 (64)	49 (67)	42 (61)

Results are presented with mean value and standard deviation (SD) or number (n) and percentage (%).

Figure 1

Flow chart of participants included in the analyses of secondary neurological outcomes.

The institutional review board of the university hospital approved the design (IRB approval number: 2022-04-012) and protocol of this retrospective study and waived the requirement for informed consent. We retrospectively reviewed the electrical medical records of 50 consecutive patients who had undergone BE-PCF from September 2018 to February 2021. These patients complained of posterior neck pain and radicular pain simultaneously, and underwent BE-PCF by a single orthopaedic surgeon (MS K) who was proficient in open microscopic PCF and had 1 year (49 cases) of experience with biportal endoscopic lumbar surgery but not with BE-PCF.
The inclusion criteria were as follows: (1) age between 18 and 80 years; (2) clinical manifestations and physical examinations consistent with single-level, unilateral cervical spondylotic radiculopathy, which was refractory to > 6 weeks of conservative treatment; and (3) lateral and foraminal cervical disc herniation or stenosis confirmed through magnetic resonance imaging (MRI). The exclusion criteria were as follows: (1) patients with cervical myelopathy with cord signal change upon MRI, segmental instability, and presence of hypoplasia of the lateral mass and cervical deformities; (2) patients with central localisation of the disc herniation or multi-level cervical spinal stenosis; (3) patients with prior surgery at the same level; and (4) patients who had not been followed up for > 1 year.