Neck pain with radiculopathy
Neck and referred arm pain (radiculopathy) is common and constitutes a significant workload for both primary and secondary care. These conditions cause significant disability and lost work time in the population. There are various treatment modalities available and we aim to compare them.
Focus of the review
The focus of the overview is to compare the existing treatments but avoid comparing between different types of treatment (e.g., different types of surgery). Purely applying a 'watch and wait' treatment plan is uncommon. Typically, patients are treated with either oral analgesics, other conservative care (including physiotherapy), injections, or surgery. Therefore, we have attempted to compare these modalities.
Comments on evidence
Overall, there are few high-quality studies in this area. We only found one RCT and three systematic reviews that conformed to our analysis. There are several studies that compare different types of one modality of treatment; for example, different routes of administration for an injection or different types of surgery (anterior cervical discectomy and fusion versus cervical disc replacement). Thus, the limitations in this overview reflect the overall limitations in the available evidence.
Search and appraisal summary
The update literature search for this overview was carried out from the date of the last search, May 2007, to September 2014. A back search from 1966 was performed for the new options added to the scope at this update. For more information on the electronic databases searched and criteria applied during assessment of studies for potential relevance to the overview, please see the Methods section. Searching of electronic databases retrieved 368 studies. After deduplication and removal of conference abstracts, 226 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 142 studies and the further review of 41 full publications. Of the 41 full articles evaluated, four systematic reviews and one RCT were added at this update.
Substantive changes at this update
Drug treatments (paracetamol, NSAIDs, antidepressants, and muscle relaxants) for neck pain with radiculopathy New option. No new evidence added. Categorised as 'unknown effectiveness'.
Epidural injections or nerve root blocks (corticosteroid with or without local anaesthetic) New option. One systematic review added. Categorised as 'unknown effectiveness'.
INTRODUCTION: Non-specific neck pain has a postural or mechanical basis and affects about two-thirds of people at some stage, especially in middle age. Acute neck pain resolves within days or weeks, but may become chronic in about 10% of people. Whiplash injuries follow sudden acceleration-deceleration of the neck, such as in road traffic or sporting accidents. Up to 40% of people continue to report symptoms 15 years after the accident, although this varies between countries. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical questions: What are the effects of surgical treatments for neck pain with radiculopathy? What are the effects of injection treatments for neck pain with radiculopathy? What are the effects of drug treatments for neck pain with radiculopathy? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2014 (BMJ Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). RESULTS: At this update, searching of electronic databases retrieved 368 studies. After deduplication and removal of conference abstracts, 226 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 142 studies and the further review of 41 full publications. Of the 41 full articles evaluated, four systematic reviews and one RCT were added at this update. We performed a GRADE evaluation for three PICO combinations. CONCLUSIONS: In this systematic overview, we categorised the efficacy for three interventions based on information about the effectiveness and safety of drug treatments, injection treatments, and surgical treatments.
Cervical Disc Arthroplasty Versus Anterior Cervical Discectomy and Fusion for Incidence of Symptomatic Adjacent Segment Disease: A Meta-Analysis of Prospective Randomized Controlled Trials. ( 10 January 2017 )
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