Two-hundred and two participants were consecutively recruited at four neurosurgery/neuro-orthopaedic clinics in Sweden between 2009 and 201212 (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 ).
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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 (%).
Flow chart of participants included in the analyses of secondary neurological outcomes.
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