Nonsurgical versus surgical treatment for cervical radiculopathy: a systematic review and meta-analysis of randomized controlled trials.

Abstract

PURPOSE: There is conflicting evidence regarding the optimal management strategy for cervical radiculopathy. We conducted a meta-analysis to evaluate the relative effectiveness of nonsurgical treatment and surgical care in adult patients with cervical radiculopathy. METHODS: We systematically searched PubMed, Embase, and the Cochrane Library to identify randomized controlled trials (RCTs) comparing nonsurgical treatment with surgical treatment. All statistical analyses were performed using RevMan version 5.4. RESULTS: Five RCTs met the inclusion criteria. Surgical treatment significantly improved neck pain (SMD 0.70, 95% CI 0.15–1.26) and arm pain (SMD 0.62, 95% CI 0.04–1.19) compared with non-surgical care. Subgroup analysis showed that benefits for neck pain were most pronounced in patients with disc herniation (SMD 1.02, 95% CI 0.11–1.93) and in those with unspecified pathology (SMD 1.23, 95% CI 0.69–1.77), whereas benefits for arm pain were observed only in disc herniation (SMD 1.29, 95% CI 0.90–1.68). Surgical treatment also improved physical function (SMD 0.33, 95% CI 0.06–0.59) but did not significantly affect emotional/mood outcomes (SMD 0.22, 95% CI − 0.02 to 0.45), patient-reported overall improvement (RR 0.97, 95% CI 0.72–1.31), or analgesic use (RR 1.03, 95% CI 0.77–1.36). CONCLUSIONS: Surgical management of cervical radiculopathy may provide superior improvements in neck and arm pain, as well as functional outcomes, compared with non-surgical treatment, particularly in patients with disc herniation. Further high-quality trials are warranted to confirm these findings and define optimal patient selection.