Fouyas I P, Statham P F, Sandercock P A, Lynch C
Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh, Crewe Road, Edinburgh, Scotland, UK, EH4 2XU.
Cochrane Database Syst Rev. 2001(3):CD001466. doi: 10.1002/14651858.CD001466.
Cervical spondylosis causes pain and disability by compressing the spinal cord or roots. Surgery to relieve the compression may reduce the pain and disability, but is associated with a small but definite risk. We sought to assess the balance of risk and benefit from surgery.
To determine whether: 1) surgical treatment of cervical radiculopathy or myelopathy is associated with improved outcome, compared with conservative management and 2) timing of surgery (immediate or delayed upon persistence/progression of relevant symptoms and signs) has an impact on outcome.
We searched Medline (between 1966 and 1998), Embase (between 1980 and 1998) and the Cochrane Controlled Trials Register. Authors of the identified randomised controlled trials were contacted to detect any additional published or unpublished data.
All unconfounded truly or quasi-randomised controlled trials allocating patients with cervical radiculopathy or myelopathy to 1) "best medical management" or "decompressive surgery (with or without some form of fusion) plus best medical management" 2) "early decompressive surgery" or "delayed decompressive surgery".
Two reviewers independently selected trials for inclusion, assessed trial quality and extracted the data.
Two trials involving a total of 130 patients were included. One trial with 81 patients compared surgical decompression with either physiotherapy or cervical collar immobilization in patients with cervical radiculopathy. The short-term effects of surgery, in terms of pain, weakness or sensory loss were superior, however, at one year no significant differences between groups were present. One trial with 49 patients compared the effects of surgery with those of conservative treatment in patients with mild functional deficit associated with cervical myelopathy. No significant differences were observed between groups, up to two years following treatment.
颈椎病通过压迫脊髓或神经根导致疼痛和功能障碍。缓解压迫的手术可能会减轻疼痛和功能障碍，但存在一定的明确风险。我们旨在评估手术的风险和益处的平衡。
确定：1）与保守治疗相比，颈椎神经根病或脊髓病的手术治疗是否能改善预后；2）手术时机（在相关症状和体征持续/进展时立即手术或延迟手术）是否会影响预后。
我们检索了医学文献数据库（1966年至1998年）、荷兰医学文摘数据库（1980年至1998年）和Cochrane对照试验注册库。联系已识别的随机对照试验的作者以查找任何其他已发表或未发表的数据。
所有将颈椎神经根病或脊髓病患者分配至以下情况的无混淆的真正或准随机对照试验：1）“最佳药物治疗”或“减压手术（有或无某种形式的融合）加最佳药物治疗”；2）“早期减压手术”或“延迟减压手术”。
两名评价者独立选择纳入试验，评估试验质量并提取数据。
纳入了两项共涉及130例患者的试验。一项有81例患者的试验比较了颈椎神经根病患者手术减压与物理治疗或颈托固定的效果。就疼痛、无力或感觉丧失而言，手术的短期效果更佳，然而，在一年时两组之间无显著差异。一项有49例患者的试验比较了轻度功能缺陷相关的颈椎脊髓病患者手术与保守治疗的效果。治疗后两年内两组之间未观察到显著差异。
