National Guideline Clearinghouse | Techniques for anterior cervical decompression for radiculopathy.

Guideline Title
Techniques for anterior cervical decompression for radiculopathy.

Bibliographic Source(s)
Matz PG, Ryken TC, Groff MW, Vresilovic EJ, Anderson PA, Heary RF, Holly LT, Kaiser MG, Mummaneni PV, Choudhri TF, Resnick DK, Joint Section on Disorders of the Spine and Peripheral Nerves [trunc]. Techniques for anterior cervical decompression for radiculopathy. J Neurosurg Spine 2009 Aug;11(2):183-97. [42 references] PubMed

Guideline Status
This is the current release of the guideline.


full-text:
National Guideline Clearinghouse | Techniques for anterior cervical decompression for radiculopathy.







J Neurosurg Spine. 2009 Aug;11(2):183-97.

Techniques for anterior cervical decompression for radiculopathy.

Matz PG, Ryken TC, Groff MW, Vresilovic EJ, Anderson PA, Heary RF, Holly LT, Kaiser MG, Mummaneni PV, Choudhri TF, Resnick DK; Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons and Congress of Neurological Surgeons.

Source
Division of Neurological Surgery, University of Alabama, Birmingham, Alabama, USA. matzpg@yahoo.com

Abstract
OBJECT: The objective of this systematic review was to use evidence-based medicine to identify the best techniques for anterior cervical nerve root decompression.

METHODS: The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to techniques for the surgical management of cervical radiculopathy. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I-III). The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer-review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons.

RESULTS: Both anterior cervical discectomy (ACD) and anterior cervical discectomy with fusion (ACDF) are equivalent treatment strategies for 1-level disease with regard to functional outcome (Class II). Anterior cervical discectomy with fusion may achieve a more rapid reduction of neck and arm pain compared to ACD with a reduced risk of kyphosis, although functional outcomes may be similar. Anterior cervical discectomy with fusion is not a lasting means of increasing foraminal or disc height compared to ACD. Anterior cervical plating (ACDF with instrumentation) improves arm pain (but not other clinical parameters) better than ACDF in the treatment of 2-level disease (Class II). With respect to 1-level disease, plating may reduce the risk of pseudarthrosis and graft problems (Class III) but does not necessarily improve clinical outcome alone (Class II). Cervical arthroplasty is recommended as an alternative to ACDF in selected patients for control of neck and arm pain (Class II).

CONCLUSIONS: Anterior cervical discectomy, ACDF, and arthroplasty are effective techniques for addressing surgical cervical radiculopathy.

PMID:19769498[PubMed - indexed for MEDLINE]

Techniques for anterior cervical decompression for... [J Neurosurg Spine. 2009] - PubMed result