Randomized trial of anterior cervical discectomy and fusion for radiculopathy


Anterior cervical discectomy and fusion (ACDF) significantly enhances clinical outcomes at two years when compared to non-operative treatment for cervical radiculopathy. However, there is little evidence to suggest benefit beyond this period. In this Swedish multicenter randomized study, 5-8 year outcomes (mean 70 months) were prospectively assessed in patients after 3 or more months of physical therapy (PT; n = 29) versus ACDF combined with PT (n = 30). Initial average visual analog scale (VAS) arm pain scores in the two treatment groups were 45 and 44 mm, respectively. Seven patients in the PT group ultimately underwent surgery at 6 to 24 months follow-up. Intention-to-treat analysis revealed that the ACDF + PT group had significant improvement in neck disability index (21 versus 11, p = 0.03) and VAS neck pain (39 versus 19 mm, p = 0.01). Patients in the surgical group also rated symptoms to be “better / much better” significantly more often (93% versus 62%, p = 0.005). However, no statistically significant differences were noted in VAS arm pain (33 mm versus 19 mm, p = 0.1) or EQ-5D (0.29 versus 0.14, p = 0.12). Patients had significant improvement over baseline clinical measures irrespective of treatment. This study adds valuable insight into long-term cervical radiculopathy outcomes.

H. Francis Farhadi, MD PhD
Columbus, OH
Vibhu K. Viswanathan, MBBS
Columbus, OH