Non-operative management is associated with similar long-term patient-reported outcomes compared to surgery for cervical radiculopathy: A Systematic Review and Meta-analysis

Why This Matters

For patients with cervical radiculopathy, deciding when to continue non-operative management and when to consider surgery is an important clinical question. Surgery may be appropriate for selected patients, but whether earlier operative intervention provides better long-term patient-reported outcomes remains uncertain.

This systematic review and meta-analysis compared surgical and non-operative management and found no significant differences in pain, disability, or overall clinical success after 12 months. Importantly, the findings apply to patients selected for each management approach and should not be interpreted to mean that surgery and non-operative care are therapeutically equivalent.

What the Research Found

This systematic review and meta-analysis included 12 randomized and observational studies involving 1,127 patients with cervical radiculopathy. Of these, 487 underwent surgery and 640 received non-operative management.

Researchers compared neck and arm pain, Neck Disability Index (NDI), overall clinical success, analgesic use, and sick leave. At 12 months, surgery was not associated with superior pain or disability outcomes. Most included studies were rated as having a serious risk of bias, and the overall certainty of evidence was moderate.

KEY POINTS

• Long-term arm pain outcomes were comparable. Surgery was not associated with significantly better arm pain scores after 12 months.
• Neck pain and disability showed a similar pattern. No significant advantage for surgery was identified for neck pain or NDI after 12 months.
• Overall clinical success did not significantly differ between groups. The pooled relative risk for overall success was 1.05, with no significant difference between surgical and non-operative management.
• Analgesic use and sick leave were also similar at final follow-up. Neither outcome differed significantly between the treatment groups.
• The findings do not establish therapeutic equivalence. The authors emphasize that these results reflect outcomes among patients selected for surgical or non-operative management, and most included studies had a serious risk of bias.