Cervical
An evidence-based clinical guideline for the diagnosis and treatment of cervical radiculopathy from degenerative disorders.
Bono CM, Ghiselli G, Gilbert TJ, et al.
Spine J. 2011; 11: 64-72.
PMID: 21168100
This summary of NASS’s clinical guideline for degenerative cervical radiculopathy addresses 18 clinical questions based on a rigorous review of published evidence. Good evidence was available except for non-surgical treatment and long-term outcomes. This document should be the definitive starting point for reading about the treatment of cervical radiculopathy.
web: http://download.journals.elsevierhealth.com/pdfs/journals/1529-9430/PIIS1529943010013264.pdf
Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease.
Jacobs W, Willems PC, van Limbeek J, Bartels R, Pavlov P, Anderson PG, Oner C.
Cochrane Database Syst Rev. 2011; 1: CD004958.
PMID: 21249667
This systematic review compared the effectiveness of various forms of anterior cervical interbody fusion in 33 randomized controlled trials. There were surprisingly few differences in outcomes between techniques. An excellent review of the comparative literature; highly useful in selecting between various anterior cervical fusion procedures.
web: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004958.pub2/abstract
Epidemiology of cervical radiculopathy: A population-based study from Rochester, Minnesota, 1976 through 1990.
Radhakrishnan K, Litchy WJ, O’Fallon M, Kurland LT.
Brain. 1994; 117: 325-335.
PMID: 8186959
This epidemiological study reports on the incidence and characteristics of cervical radiculopathy from a complete local population during a quarter century. Three-quarters of patients were treated conservatively and 90% were normal or mild at median 5-year follow-up. This study provides a unique picture on the epidemiology and course of radiculopathy.
web: http://brain.oxfordjournals.org/content/117/2/325.abstract
Philadelphia Panel Evidence-Based Clinical Practice Guidelines on Selected Rehabilitation Interventions for Neck Pain.
Philadelphia Panel.
Phys Ther. 2001; 81: 1701-1717.
PMID: 11589644
This clinical guideline is based on a rigorous systematic review of studies on various forms of non-operative treatment of acute or chronic neck pain with or without radiculopathy. Since conservative care is the prerequisite to cervical surgery, this review provides an essential guide to these (mostly unproven) forms of treatment.
web: http://ptjournal.apta.org/content/81/10/1701.full.pdf+html
Surgical management of cervical degenerative disease: the evidence related to indications, impact, and outcome.
Fehlings MG, Arvin B.
J Neurosurg Spine. 2009; 11: 97-100.
PMID: 19769487
This editorial on cervical myelopathy summarizes and introduces 17 systematic reviews from AANS/CNS on cervical degenerative disorders. They advise early surgery with any technique, and further research. This article rapidly provides an overview of the key conclusions from a suite of excellent systematic review.
Impact of surgical approach on complications and resource utilization of cervical spine fusion: a nationwide perspective to the surgical treatment of diffuse cervical spondylosis.
Shamji MF, Cook C, Pietrobon R, Tackett S, Brown C, Isaacs RE.
Spine J. 2009; 9: 31-38.
PMID: 18790678
This paper reports on perioperative complications from 4-8 level cervical fusion in a very large sample from a national database. Posterior surgeries had higher rates of respiratory complications, transfusions, infections, and non-routine discharge, and 50% higher costs. This paper provides the definitive rate of complications to use in counseling patients.
web: http://www.thespinejournalonline.com/article/S1529-9430%2808%2900724-9/abstract
No Justification for Cervical Disk Prostheses in Clinical Practice: A Meta-Analysis of Randomized Controlled Trials.
Bartels RHMA, Donk R, Verbeek ALM.
Neurosurgery. 2010; 66: 1153-1160.
PMID: 20421840
This rigorous metaanalysis of RCTs on cervical arthroplasty found some early clinical advantages for arthroplasty but somewhat strangely concluded against its use, due to biases in the research and higher costs. Beyond being the best available review on the topic, this article illustrates the difficulty of attaining scientifically objective conclusions.
SWISSspine: The Case of a Governmentally Required HTA-Registry for Total Disc Arthroplasty – Results of Cervical Disc Prostheses.
Schluessmann E, Aghayev E, Staub L, Moulin P, Zweig T, Röder C.
Spine. 2010; 35: E1397-E1405.
PMID: 21030901
This study used a mandatory national patient registry to report the outcomes from a large, complete population of patients receiving cervical arthroplasty. It provides a picture of the real-world outcomes that can be expected, and it serves as a model for the kind of research insurance companies will increasingly require.
Anterior cervical surgery for the treatment of cervical degenerative myelopathy.
Matz PG, Holly LT, Mummaneni PV, et al.
J Neurosurg Spine. 2009; 11: 170-173.
PMID: 19769496
This treatment guideline on cervical myelopathy from AANS/CNS is based on a systematic review. There were only a few level II studies available, so their recommendations were weak, and they urged further high-quality research. The best review paper available on treatment of cervical myelopathy.
Degenerative cervical spondylosis: clinical syndromes, pathogenesis, and management.
Rao RD, Currier BL, Albert TJ, Bono CM, Marawar SV, Poelstra KA, Eck JC.
J Bone Joint Surg Am. 2007; 89: 1360-1378.
PMID: 17575617
This narrative review paper on cervical spondylosis is informative and well-illustrated. It discusses the pathogenesis, clinical exam, imaging, non-operative treatment, surgical indications, surgical techniques, clinical outcomes, and complications for axial neck pain, radiculopathy, and myelopathy. This paper is an excellent educational introduction to degenerative cervical spondylolsis.