Cervical Degenerative Disease Treatment: A Systematic Review
Comparative Effectiveness Review, No. 266
Authors
Investigators: Shelley S. Selph, M.D., M.P.H., Andrea C. Skelly, Ph.D., M.P.H., Rebecca M. Jungbauer, Dr.P.H., M.A., Erika Brodt, B.S., Ian Blazina, M.P.H., Travis C. Philipp, M.D., Kimberly M. Mauer, M.D., Joseph Dettori, Ph.D., M.P.H., M.P.T., Chandler Atchison, M.P.H., Dakota Riopelle, M.P.H., Shay Stabler-Morris, M.S., Rochelle Fu, Ph.D., Yun Yu, M.S., and Roger Chou, M.D.ReadAbstract
Objectives:
Cervical degenerative disease (CDD) is common, becomes more prevalent with age, and is managed with surgical and nonoperative treatments to alleviate pain, improve function, and prevent progression or recurrence. This systematic review summarizes the evidence on treatments for CDD.
Data sources:
We searched Ovid MEDLINE®, Embase®, and Cochrane CENTRAL from 1980 to February 15, 2023; reference lists; and clinical trial registries.
Review methods:
Predefined criteria were used to identify studies; prespecified methods were used to assess study quality and strength of evidence for key outcomes. Effects were analyzed qualitatively and quantitatively where appropriate.
Results:
We included 57 randomized controlled trials, 56 nonrandomized studies, and 1 systematic review. Studies enrolled patients with radiculopathy and/or myelopathy with disease at one or more levels. A variety of surgical approaches were used; there were few comparative studies of nonoperative treatments. Most studies were rated moderate risk of bias, while the majority of evidence was rated low or insufficient strength to draw conclusions on comparative benefits and harms.
Cervical arthroplasty versus anterior cervical discectomy and fusion (ACDF): In single-level disease, there were no important differences between cervical arthroplasty and ACDF in pain or function. Cervical arthroplasty was associated with a lower likelihood of reoperation and slightly lower likelihood of any serious adverse event (SAE) in the short term, with no difference between cervical arthroplasty and ACDF in SAEs longer term. In patients with 2-level disease, pain, function, and likelihood of reoperation at the index level were similar, but the likelihood of an adverse event was slightly lower at 24 months with cervical arthroplasty, with no difference at 120 months.
Anterior versus posterior approach: There was no difference between these approaches in pain, function, quality of life, and reoperation in patients with fewer than three operated levels. Limited evidence suggests that a posterior approach is associated with a greater likelihood of experiencing any SAE in patients with procedures at three or more levels.
Standalone cage versus plate and cage in ACDF: Fusion rates were similar between standalone cage versus plate and cage; there were no differences between treatments in postoperative arm pain, function, quality of life, or adjacent-level ossification.
Laminoplasty versus laminectomy and fusion. There was little difference between surgical techniques in postoperative function, but the risk of experiencing a complication was lower with laminoplasty, with no difference in reoperation rates.
Conclusions:
There were few differences in benefits between surgical approaches and techniques for the treatment of CDD. However, there were some differences in the frequency of adverse events for some comparisons.
Suggested citation:
Selph SS, Skelly AC, Jungbauer RM, Brodt E, Blazina I, Philipp TC, Mauer KM, Dettori J, Atchison C, Riopelle D, Stabler-Morris S, Fu R, Yu Y, Chou R. Cervical Degenerative Disease Treatment: A Systematic Review. Comparative Effectiveness Review No. 266. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 75Q80120D00006.) AHRQ Publication No. 24-EHC001. Rockville, MD: Agency for Healthcare Research and Quality; November 2023. DOI: https://doi.org/10.23970/AHRQEPCCER266. Posted final reports are located on the Effective Health Care Program search page.
This report is based on research conducted by the Pacific Northwest Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 75Q80120D00006). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
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A representative from AHRQ served as a Contracting Officer’s Representative and reviewed the contract deliverables for adherence to contract requirements and quality. AHRQ did not directly participate in the literature search, determination of study eligibility criteria, data analysis, interpretation of data, or preparation or drafting of this report.
AHRQ appreciates appropriate acknowledgment and citation of its work. Suggested language for acknowledgment: This work was based on an evidence report, Cervical Degenerative Disease Treatment: A Systematic Review, by the Evidence-based Practice Center Program at the Agency for Healthcare Research and Quality (AHRQ).