Nonsurgical versus surgical treatment for cervical radiculopathy: a systematic review and meta-analysis of randomized controlled trials.

PURPOSE: There is conflicting evidence regarding the optimal management strategy for cervical radiculopathy. We conducted a meta-analysis to evaluate the relative effectiveness of nonsurgical treatment and surgical care in adult patients with cervical radiculopathy.

METHODS

We systematically searched PubMed, Embase, and the Cochrane Library to identify randomized controlled trials (RCTs) comparing nonsurgical treatment with surgical treatment. All statistical analyses were performed using RevMan version 5.4.

RESULTS

Five RCTs met the inclusion criteria. Surgical treatment significantly improved neck pain (SMD 0.70, 95% CI 0.15–1.26) and arm pain (SMD 0.62, 95% CI 0.04–1.19) compared with non-surgical care. Subgroup analysis showed that benefits for neck pain were most pronounced in patients with disc herniation (SMD 1.02, 95% CI 0.11–1.93) and in those with unspecified pathology (SMD 1.23, 95% CI 0.69–1.77), whereas benefits for arm pain were observed only in disc herniation (SMD 1.29, 95% CI 0.90–1.68). Surgical treatment also improved physical function (SMD 0.33, 95% CI 0.06–0.59) but did not significantly affect emotional/mood outcomes (SMD 0.22, 95% CI − 0.02 to 0.45), patient-reported overall improvement (RR 0.97, 95% CI 0.72–1.31), or analgesic use (RR 1.03, 95% CI 0.77–1.36).

CONCLUSIONS

Surgical management of cervical radiculopathy may provide superior improvements in neck and arm pain, as well as functional outcomes, compared with non-surgical treatment, particularly in patients with disc herniation. Further high-quality trials are warranted to confirm these findings and define optimal patient selection.