Fouyas I P, Sandercock P A G, Statham P F, Lynch C
Ward 40, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK, AB10 1UX.
Cochrane Database Syst Rev. 2007 Jul 18(2):CD001466. doi: 10.1002/14651858.CD001466.pub2.
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 Authors of the identified randomised controlled trials were contacted to detect any additional published or unpublished data.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 authors 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.
AUTHORS' CONCLUSIONS: The available small randomised trials do not provide reliable evidence on the effects of surgery for cervical spondylotic radiculopathy or myelopathy. It is not clear whether the short-term risks of surgery are offset by any long-term benefits.
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减轻疼痛和功能障碍，但伴有一定的小风险。我们试图评估手术的风险和益处的平衡。
确定：1）与保守治疗相比，手术治疗神经根型或脊髓型颈椎病是否能改善预后；2）手术时机（相关症状和体征持续/进展后立即或延迟手术）是否对预后有影响。
我们检索了Medline（1966年至1998年）、Embase（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。
所有将神经根型或脊髓型颈椎病患者分配至以下情况的无混杂因素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”。
两位作者独立选择纳入试验，评估试验质量并提取数据。
纳入两项试验，共130例患者。一项有81例患者的试验比较了神经根型颈椎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，一年时两组间无显著差异。一项有49例患者的试验比较了轻度功能障碍伴脊髓型颈椎病患者手术与保守治疗的效果。治疗后两年内两组间未观察到显著差异。
现有的小型随机试验未提供关于手术治疗神经根型或脊髓型颈椎病效果的可靠证据。尚不清楚手术的短期风险是否被任何长期益处所抵消。
