SURGICAL VERSUS NONSURGICAL TREATMENT FOR CERVICAL RADICULOPATHY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Abstract

ABSTRACT Cervical radiculopathy is a common condition affecting the cervical spine. Few trials with a small number of patients tried to establish the most efficient treatment in the literature that varies between surgical and nonsurgical approaches. We conducted a systematic review and meta-analysis to evaluate surgical versus nonsurgical treatment efficacy for cervical radiculopathy PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched from inception to July 2025 to identify randomized controlled trials (RCTs) studies comparing surgical and nonsurgical treatment on adult patients with cervical radiculopathy. Outcomes of interest included Neck Disability Index (NDI), Arm pain and Neck pain (pain grade measured by Visual Analogue Scale and Numeric Rating Scale). We calculated the mean difference for each comparison and did a conventional random effects meta-analysis. We included 4 RCTs with 323 total patients with 161 randomized to surgery group and 162 to nonsurgery group. Mean difference NDI score of surgical vs. nonsurgical group at 12 months follow-up has no statistically significant difference (MD: -2.54 95% CI: -6.33 to 1.24; I2=52%; P=0.19). Short-term outcomes were also analyzed, resulting in a rapid efficacy of surgical treatment and a progressive efficacy of nonsurgical therapy on 3 months follow-up (MD: -7.61 95% CI: -12.48 to -2.74; I2=0%; P=0.002) and 6 months follow-up (MD: -5.87 95% CI: -9.59 to -2.15; I2=0%; P=0.002). Surgical group was associated with a considerable reduction of arm pain (MD: -1.17; 95% CI: -1.66 to -0.68; I2=0%; P<0.00001) and neck pain (MD: -0.84; 95% CI: -1.38 to -0.31; I2=23%; P=0.002) on the comparative analysis of both groups. These findings suggest a mid-term association of quality of life and pain reduction in patients with cervical radiculopathy who underwent surgery compared to nonsurgical treatments. The long-term comparison between surgical and nonsurgical therapy showed no statistically significant difference. Level of Evidence: II; Systematic Review/Meta-analysis.