Arthroplasty and fusion offer similar results out to five years for patients with cervical radiculopathy

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Arthroplasty and fusion are comparable treatment options for cervical radiculopathy and have similar long-term efficacy, findings from a randomised controlled trial (RCT) have shown.  

The data, which were published by Tonje Johansen (St Olavs Hospital, Trondheim, Norway) et al in the Journal of the American Medical Association (JAMA) indicated that there were similar and statistically significant improvements in Neck Disability Index (NDI) scores for both treatment groups at five-year follow-up.

There was however no statistically significant difference in change of NDI score at five years between patients who underwent arthroplasty and those who underwent fusion.

The multicentre, single-blinded, RCT included patients aged 25 to 60 years with C6 or C7 radiculopathy who had been referred to study sites’ outpatient clinics from 2008 to 2013.

The primary endpoint was change in NDI score. Secondary outcomes were arm and neck pain, measured with numeric rating scales (NRS); quality of life, measured with the EuroQol-5D (EQ-5D); reoperation rates; and adjacent segment disease.

A total of 114 patients completed the five-year follow-up. In the arthroplasty group, the mean NDI score was 45.9 (95% CI, 43.3 to 48.4) points at baseline and 22.2 (95% CI, 18.0 to 26.3) points at five years.

Meanwhile, in the fusion group, the mean NDI score was 51.3 (95% CI, 48.1 to 54.4) points at baseline, and 21.3 (95% CI, 17.0 to 25.6) points at five years.

The changes in mean NDI scores between baseline and five years were statistically significant for arthroplasty (mean change, 24.8 [95% CI, 19.8 to 29.9] points; P < .001) and fusion (mean change, 29.9 [95% CI, 24.0 to 35.9] points; P < .001), but the change in mean NDI scores was not significantly different between groups (difference, 5.1 [95% CI, −2.6 to 12.7] points; P = .19).

There were no significant differences in changes in arm pain (mean [SE] change, 3.5 [0.5] vs. 3.1 [0.4]; p=0.47), neck pain (mean [SE] change, 3 [0.5] vs. 3.4 [0.5]; p= 0.50), EQ-5D (mean [SE] change, 0.39 [0.4] vs. 0.45 [0.6]; p= 0.46), patients requiring reoperation (10 patients [14.7%] vs. eight patients [11.8%]; p=0.61), and adjacent segment disease (0 patients vs 1 patient [1.5%]; p=0.32) between the arthroplasty and fusion groups.


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