Study Design
Best evidence synthesis.
Objective
To identify, critically appraise, and synthesize literature from 1980 through 2006 on surgical interventions for neck pain alone or with radicular pain in the absence of serious pathologic disease.
Summary of Background Data
There have been no comprehensive systematic literature or evidence-based reviews published on this topic.
Methods
We systematically searched Medline for literature published from 1980 to 2006 on percutaneous and open surgical interventions for neck pain. Publications on the topic were also solicited from experts in the field. Consensus decisions were made about the scientific merit of each article; those judged to have adequate internal validity were included in our Best Evidence Synthesis.
Results
Of the 31,878 articles screened, 1203 studies were relevant to the Neck Pain Task Force mandate and of these, 31 regarding treatment by surgery or injections were accepted as scientifically admissible. Radiofrequency neurotomy, cervical facet injections, cervical fusion and cervical arthroplasty for neck pain without radiculopathy are not supported by current evidence. We found there is support for short-term symptomatic improvement of radicular symptoms with epidural corticosteroids. It is not clear from the evidence that long-term out comes are improved with the surgical treatment of cervical radiculopathy compared to non operative measures. However, relatively rapid and substantial symptomatic relief after surgical treatment seems to be reliably achieved. It is not evident that one open surgical technique is clearly superior to others for radiculopathy. Cervical foramenal or epidural injections are associated with relatively frequent minor adverse events (5%–20%); however, serious adverse events are very uncommon (<1%). After open surgical procedures on the cervical spine, potentially serious acute complications are seen in approximately 4% of patients.
Conclusion
Surgical treatment and limited injection procedures for cervical radicular symptoms may be reasonably considered in patients with severe impairments. Percutaneous and open surgical treatment for neck pain alone, without radicular symptoms or clear serious pathology, seems to lack scientific support.
Article PDF
Avoid common mistakes on your manuscript.
References
Carroll LJ, Cassidy JD, Peloso PM, et al. (2008) Methods for the best evidence synthesis on neck pain and its associated disorders. The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine 33(Suppl):S33–S38
Fouyas IP, Statham PF, Sandercock PA (2002). Cochrane review on the role of surgery in cervical spondylotic radiculomyelopathy. Spine 27:736–47
Geurts JW, van Wijk RM, Stolker RJ, et al. (2001). Efficacy of radiofrequency procedures for the treatment of spinal pain: a systematic review of randomized clinical trials. Reg Anesth Pain Med 26:394–400
van Limbeek J, Jacobs WC, Anderson PG, et al. (2000). A systematic literature review to identify the best method for a single level anterior cervical interbody fusion. Eur Spine J 9:129–36
Nordin M, Carragee EJ, Hogg-Johnson S, et al. (2008) Assessment of neck pain and its associated disorders. Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine 33(Suppl):S101–S122
Garvey T, Transfeldt EEM, Malcolm JRM, et al. (2002) Outcome of anterior cervical discectomy and fusion as perceived by patients treated for dominant axial-mechanical cervical spine pain. Spine 27:1887–94
Lord SM, Barnsley L, Wallis BJ, et al. (1996) Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med 335: 1721–6
Palit M, Schofferman J, Goldthwaite N, et al. (1999) Anterior discectomy and fusion for the management of neck pain. Spine 24:2224–8
Simmons EH, Bhalla SK. (1969) Anterior cervical discectomy and fusion. A clinical and biomechanical study with eight-year follow-up. J Bone Joint Surg Br 51:225–37
Whitecloud T, Seago R. (1987) Cervical discogenic syndrome: results of operative intervention in patients with positive discography. Spine 12:313–6
Barnsley L, Lord SM, Wallis BJ, et al. (1994) Lack of effect of intraarticular corticosteroids for chronic pain in the cervical zygapophyseal joints. N Engl J Med 330:1047–50
Carragee EJ, Hurwitz EL, Haldeman S. (2007) The Pyrite standard: the Midas touch in the diagnosis of axial pain syndromes. Spine J 7:27–31
Bossuyt PM, Reitsma JB, Bruns DE, et al. (2003) Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. BMJ 326:41–4
Greenhalgh T. (1997) Education and debate: papers that report diagnostic or screening tests. BMJ 315:1–12
Reid MC, Lachs MS, Feinstein AR. (1995) Use of methodological standards in diagnostic test research. Getting better but still not good. JAMA 274: 645–51
Hogg-Johnson S, van der Velde G, Carroll LJ, et al. (2008) The burden and determinants of neck pain in the general population. Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine 33(Suppl):S39 –S51
Carroll LJ, Hogg-Johnson S, van der Velde G, et al. (2008) Course and prognostic factors for neck pain in the general population. Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine 33(Suppl):S75–S82
Krakenes J, Kaale BR, Moen G, et al. (2002) MRI assessment of the alar ligaments in the late stage of whiplash injury–a study of structural abnormalities and observer agreement. Neuroradiology 44:617–24
Krakenes J, Kaale BR, Moen G, et al. (2003) MRI of the tectorial and posterior atlanto-occipital membranes in the late stage of whiplash injury. Neuroradiology 45:585–91
Krakenes J, Kaale BR, Nordli H, et al. (2003) MRanalysis of the transverse ligament in the late stage of whiplash injury. Acta Radiol 44:637–44
Kaale BR, Krakenes J, Albrektsen G, et al. (2005) Whiplash-associated disorders impairment rating: neck disability index score according to severity of MRI findings of ligaments and membranes in the upper cervical spine. J Neurotrauma 22:466–75
Dvorak J, Panjabi MM. (1987) Functional anatomy of alar ligaments. Spine 12:183–9
Stav A, Ovadia L, Sternberg A, et al. (1993) Cervical epidural steroid injection for cervicobrachialgia. Acta Anaesthesiol Scand 37:562–6
Slappendel R, Crul BJ, Braak GJ, et al. (1997) The efficacy of radiofrequency lesioning of the cervical spinal dorsal root ganglion in a double blinded randomized study: no difference between 40 degrees C and 67 degrees C treatments. Pain 73:159–63
Persson LC, Carlsson CA, Carlsson JY. (1997) Long-lasting cervical radicular pain managed with surgery, physiotherapy, or a cervical collar. A prospective, randomized study. Spine 22:751–8
Ylinen J, Salo P, Nykanen M, et al. (2004) Decreased isometric neck strength in women with chronic neck pain and the repeatability of neck strength measurements. Arch Phys Med Rehabil 85:1303–8
Gore DR, Gardner GM, Sepic SB, et al. (1986) Roentgenographic findings following anterior cervical fusion. Skeletal Radiol 15:556–9
Rosenorn J, Hansen EB, Rosenorn MA. (1983) Anterior cervical discectomy with and without fusion. A prospective study. J Neurosurg 59:252–5
van den Bent MJ, Oosting J, Wouda EJ, et al. (1996) Anterior cervical discectomy with or without fusion with acrylate. A randomized trial. Spine 21: 834–9
Abd-Alrahman N, Dokmak AS, Abou-Madawi A. (1999) Anterior cervical discectomy (ACD) versus anterior cervical fusion (ACF), clinical and radiological outcome study. Acta Neurochir 141:1089–92
Wirth FP, Dowd GC, Sanders HF, et al. (2000) Cervical discectomy. A prospective analysis of three operative techniques. Surg Neurol 53:340–6
Herkowitz HN, Kurz LT, Overholt DP. (1990) Surgical management of cervical soft disc herniation. A comparison between the anterior and posterior approach. Spine 15:1026–30
Hacker RJ, Cauthen JC, Gilbert TJ, et al. (2000) A prospective randomized multicenter clinical evaluation of an anterior cervical fusion cage. Spine 25: 2646–54
Vavruch L, Hedlund R, Javid D, et al. (2002) A prospective randomized comparison between the cloward procedure and a carbon fiber cage in the cervical spine: a clinical and radiologic study. Spine 27:1694–701
Peolsson A, Vavruch L, Hedlund R. (2007) Long term randomized comparison between a carbon fibre cage and the Cloward procedure in cervical spine. Eur Spine J 16:173–8
Peolsson A, Hedlund R, Vavruch L, et al. (2003) Predictive factors for the outcome of anterior cervical decompression and fusion. Eur Spine J 12:274–80
Cho DY, Lee WY, Sheu PC, et al. (2005) Cage containing a biphasic calcium phosphate ceramic (Triosite) for the treatment of cervical spondylosis. Surg Neurol 63:497–503
Baskin DS, Ryan P, Sonntag V, et al. (2003) A prospective, randomized, controlled cervical fusion study using recombinant human bone morphogenetic protein-2 with the CORNERSTONE-SR allograft ring and the ATLANTIS anterior cervical plate. Spine 28:1219–25
Zoega B, Karrholm J, Lind B. One-level cervical spine fusion. A randomized study, with or without plate fixation, using radiostereometry in 27 patients. Acta Orthop Scand 1998;69:363–8.
Zoega B, Karrholm J, Lind B. (1998) Plate fixation adds stability to two-level anterior fusion in the cervical spine: a randomized study using radiostereometry. Eur Spine J 7:302–7
Hacker RJ. (2005) Cervical disc arthroplasty: a controlled randomized prospective study with intermediate follow-up results. Invited submission from the joint section meeting on disorders of the spine and peripheral nerves, March 2005. J Neurosurg Spine 3:424–8
Coric D, Finger F, Boltes P. (2006) Prospective randomized controlled study of the Bryan Cervical Disc: early clinical results from a single investigational site. J Neurosurg Spine 4:31–5
Ma DJ, Gilula LA, Riew KD. (2005) Complications of fluoroscopically guided extraforaminal cervical nerve blocks. An analysis of 1036 injections. J Bone Joint Surg Am 87:1025–30
Botwin KP, Castellanos R, Rao S, et al. (2003) Complications of fluoroscopically guided interlaminar cervical epidural injections. Arch Phys Med Rehabil 84:627–33
Huston CW, Slipman CW, Garvin C. (2005) Complications and side effects of cervical and lumbosacral selective nerve root injections. Arch Phys Med Rehabil 86:277–83
Wang MC, Chan L, Maiman DJ, et al. (2007) Complications and mortality associated with cervical spine surgery for degenerative disease in the United States. Spine 32:342–7
Winslow CP, Winslow TJ, Wax MK. (2001) Dysphonia and dysphagia following the anterior approach to the cervical spine. Arch Otolaryngol Head Neck Surg 127:51–5
Bazaz R, Lee MJ, Yoo J. (2002) Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine 27:2453–8
Sagi HC, Beutler W, Carroll E, et al. (2002) Airway complications associated with surgery on the anterior cervical spine. Spine 27:949–53
Lee MJ, Bazaz R, Furey CG, et al. (2005) Influence of anterior cervical plate design on dysphagia: a 2-year prospective longitudinal follow-up study. J Spinal Disord Tech 18:406–9
Heeneman H. (1973) Vocal cord paralysis following approaches to the anterior cervical spine. Laryngoscope 83:17–21
Kriskovich MD, Apfelbau RI, Haller JR. (2000) Vocal cord paralysis after anterior cervical spine surgery: incidence, mechanism, and prevention of injury. Laryngoscope 110:1467–73
Audu P, Artz G, Scheid S, et al. (2006) Recurrent laryngeal nerve palsy after anterior cervical spine surgery: the impact of endotracheal tube cuff deflation, reinflation, and pressure adjustment. Anesthesiology 105:898–901
Flynn TB. (1982) Neurologic complications of anterior cervical interbody fusion. Spine 7:536–9
Burke JP, Gerszten PC, Welsh WC. (2005) Iatrogenic vertebral artery injury during anterior cervical spine surgery. Spine J 5:508–14
Schnee CL, Freese A, Weil RJ, et al. (1997) Analysis of harvest morbidity and radiographic outcome using autograft for anterior cervical fusion. Spine 22:2222–7
Shields LB, Raque GH, Glassman SD, et al. (2006) Adverse effects associated with high dose recombinant human bone morphogenetic protien-2 use in anterior cervical spine fusion. Spine 31:2029–30
Smucker JD, Rhee JMSK, Yoon ST, et al. (2006) Increased swelling complications associated with off-label usage of rhBMP-2 in the anterior cervical spine. Spine 31:2813–9
Kaiser MG, Haid RWSK, Yoon STHJG. (2002) Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft. Neurosurgery 50:236–8
Vaccaro AR, Falatyn SP, Scuderi GL. (1998) Early failure of long term segment anterior cervical plate fixation. J Spinal Disord 11:410–5
Jacobs WC, Anderson PG, Limbeek J, et al. Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease. Cochrane Database of Systematic Reviews 2004;4:CDOO4958.
Beaton DE, Boers M, Wells GA. (2002) Many faces of the minimal clinically important difference (MCID): a literature review and directions for future research. Curr Opin Rheumatol 14:109–14
McGuire W. (2006) Parachute approach to evidence based medicine: arguments are easily refuted. BMJ 333:808
Potts M, Prata N, Walsh J, et al. (2006) Parachute approach to evidence based medicine. BMJ 333:701–3
Reeves BC. (2006) Parachute approach to evidence based medicine: as obvious as ABC. BMJ 222:701–3
Smith GC. (2003) Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomized controlled trial. BMJ 327:1459–61
Côté P, van der Velde G, Cassidy JD, et al. (2008) The burden and determinants of neck pain in workers. Results of the Bone and Joint 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine 33(Suppl):S60 –S74
Holm LW, Carroll LJ, Cassidy JD, et al. (2008) The burden and determinants of neck pain in whiplash-associated disorders after traffic collisions: Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine 33(Suppl):S52–S59
Carroll LJ, Holm LW, Hogg-Johnson S, et al. (2008) Course and prognostic factors for neck pain in whiplash-associated disorders (WAD). Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine 33(Suppl):S83–S92
Carroll LJ, Hogg-Johnson S, Côté P, et al. (2008) Course and prognostic factors for neck pain in workers. Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine 33(Suppl): S93–S100
Kaale BR, Krakenes J, Albrektsen G, et al. (2005) Head position and impact direction in whiplash injuries: associations with MRI-verified lesions of ligaments and membranes in the upper cervical spine. J Neurotrauma 22:1294–302
Abdi S, Datta S, Trescot AM, et al. (2007) Epidural steroids in the management of chronic pain: a systematic review. Pain Physician 10:185–212
Boswell MV, Shah RV, Everett CR, et al. (2005) Intervention techniques in the managment of chronic pain: evidence-based practice guidelines. Pain Physician 8:1–47
Boswell MV, Trescot AM, Datta A, et al. (2007) Interventional techniques: evidence- based practice guidelines in the management of chronic spinal pain. Pain Physician 10:7–111
Riew KD, Park JB, Cho YS, et al. (2006) Nerve root blocks in the treatment of lumbar radicular pain. A minimum five-year follow-up. J Bone Joint Surg Am 88:1722–5
Weinstein JN, Lurie JD, Tosteson TD, et al. (2006) Surgical vs nonoperative treatment for lumbar disk herniation: the spinal patient outcomes research trial (SPORT) observation cohort. JAMA 296:2441–50
Zoega B, Karrholm J, Lind B (2000). Outcome scores in degenerative cervical disc surgery. Eur Spine J 9:137–43
Peolsson A, Vavruch L, Oberg B. (2006) Predictive factors for arm pain, neck pain, neck specific disability and health after anterior cervical decompression and fusion. Acta Neurochir 148:167–73
Fenton JJ, Mirza SK, Lahad A, et al. (2007) Variation in reported safety of lumbar interbody fusion: influence of industrial sponsorship and other study characteristics. Spine 32:471–80
Martin BI, Mirza SK, Comstock BA, et al. (2007). Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures. Spine 32:387
Carragee E, Alamin T. A Prospective Assessment of Patient Expectations and Satisfaction in Spinal Fusion Surgery. Proceeding of the International Society for the Study of the Lumbar Spine, 2003.
Carragee EJ, Lincoln T, Parmar VS, et al. (2006). A gold standard evaluation of the ‘discogenic pain’ diagnosis as determined by proactive discography. Spine 31:2115–23
Author information
Authors and Affiliations
Corresponding author
Additional information
The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.
Corporate/Industry, Foundation, and Professional Organizational funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.
Reprinted with permission from Lippincott Williams & Wilkins, Carragee EJ, Hurwitz EL, Cheng I, et al., Treatment of Neck Pain, Injections and Surgical Interventions: Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders, SPINE, Volume 33, Number 4S, pp S153–S169
Rights and permissions
About this article
Cite this article
Carragee, E.J., Hurwitz, E.L., Cheng, I. et al. Treatment of Neck Pain. Eur Spine J 17 (Suppl 1), 153–169 (2008). https://doi.org/10.1007/s00586-008-0632-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-008-0632-y