LONG-LASTING CERVICAL RADICULAR PAIN MANAGED WITH SURGERY, PHYSIOTHERAPY, OR A CERVICAL COLLAR - A PROSPECTIVE, RANDOMIZED STUDY

Study Design. This prospective, randomized study compares the efficacy of surgical and conservative treatments in patients with long-lasting cervical radicular pain. Objectives. To compare the effects of surger y, physiotherapy, and a cervical collar. Summary of Background Data. T here are no previous controlled outcome studies that have compared sur gical treatment with nonsurgical treatment of patients with cervical r adicular pain. Methods. The study group comprised 81 patients with cer vicobrachial pain of at least 3 months' duration, in whom the distribu tion of the arm pain corresponded to a nerve root that was significant ly compressed by spondylotic encroachment with or without an additiona l bulging disc, as verified by magnetic resonance imaging or computed tomographic myelography. The patients were randomly allocated to surge ry (Cloward technique), individually adapted physiotherapy, or a cervi cal collar. The therapeutic effects were evaluated with respect to pai n intensity by the visual analogue scale, function by the Sickness Imp act Profile, and mood by the Mood Adjective Check List. The measuremen ts were performed before treatment (control 1), shortly after treatmen t (control 2), and after a further 12 months (control 3). Results. At control 1, the groups were uniform. At central 2, the surgery group re ported less pain (visual analogue scale) and, like the physiotherapy g roup, better function (Sickness Impact Profile) than the collar group. At control 3, there was no difference in visual analogue scale, Sickn ess Impact Profile, and Mood Adjective Check List measurements among t he groups. Conclusions. In the treatment of patients with long-lasting cervical radicular pain, it appears that a cervical collar, physiothe rapy, or surgery are equally effective in the long term.