review · Spine
A systematic review assessed the effectiveness of conservative and surgical interventions for cervical disc herniation across eleven randomised controlled trials. One trial compared conservative management with surgery, whilst ten compared different surgical procedures. No evidence was found to support the effectiveness of conservative treatments, such as anti-inflammatory drugs and physiotherapy, compared with percutaneous nucleoplasty. Among surgical methods, moderate evidence favoured anterior cervical discectomy with fusion using a titanium cage over polymethyl methacrylate, as well as specific disc prostheses over bone allografts with plating. However, evidence comparing simple discectomy to discectomy with fusion was conflicting, and data for other techniques remained limited. Overall, no single surgical procedure demonstrated clear superiority. Simple anterior cervical discectomy without supplementary implants offers similar outcomes to fusion procedures, alongside lower healthcare costs and potentially reduced risks of adjacent-level disease.
Cervical disc herniation causes debilitating neck and arm pain, yet clear clinical evidence guiding intervention choices remains scarce. Although costly spinal implants are routinely used worldwide, simpler discectomy procedures without supplementary grafts achieve comparable outcomes. Recognising this helps healthcare systems, surgeons, and insurers select cost-effective procedures that minimise unnecessary implant expenditure while reducing the potential risk of adjacent-level spinal disease.
The findings directly inform spinal implant manufacturers, healthcare procurement bodies, and surgical teams. Because clinical evidence indicates simple discectomy provides similar outcomes to implant-based fusion at lower cost, medical device companies require more robust trial evidence to justify adoption of expensive hardware. These comparative insights are immediately applicable to clinical guideline development and hospital procurement decisions regarding spinal prostheses and fusion cages.
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STUDY DESIGN: Systematic review. OBJECTIVE: To assess the effectiveness of interventions for treating cervical disc herniation. SUMMARY OF BACKGROUND DATA: Cervical disc herniation is 1 of the 23 specific disorders included in the CANS (Complaints of the Arm, Neck, and/or Shoulder) model. Treatment options range from conservative to surgical, but evidence for the effectiveness of these interventions is not yet well documented. METHODS: The Cochrane Library, MEDLINE, EMBASE, PEDro, and CINAHL were searched for relevant systematic reviews and randomized clinical trials (RCTs) up to February 2009. Two reviewers independently selected relevant studies, assessed the methodological quality, and extracted data. RESULTS: Pooling of the data was not possible; thus, a best-evidence synthesis was used to summarize the results. Of the 11 RCTs included, 1 compared conservative with surgical intervention, and 10 compared various surgical interventions. No evidence was found for the effectiveness of conservative treatment (nonsteroidal anti-inflammatory drugs, cortisonics, and physical therapy) compared with percutaneous nucleoplasty. Moderate evidence was found for the effectiveness of anterior cervical discectomy with fusion (ACDF) using a titanium cage compared with ACDF using polymethyl methacrylate, and for BRYAN cervical disc (Medtronic Sofamor Danek, Memphis, TN) prostheses compared with ACDF using allograft bone and plating. No outcomes regarding adjacent-level disease were reported. There is conflicting evidence for the effectiveness of ACD compared with ACDF. Only limited or no evidence was found for the other surgical interventions. CONCLUSION: No evidence for effectiveness of conservative treatment compared with surgery was found. Although there is moderate evidence for the effectiveness of some surgical interventions, no unequivocal evidence for the superiority of 1 particular surgical treatment was found. Worldwide, most patients receive supplementary implants; however, cervical discectomy without graft may be preferred because of similar outcomes, lower costs, and possibly a lower risk of adjacent-level disease. More high-quality RCTs using validated outcome measures (including adjacent level disease) are needed.
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DOI: 10.1097/brs.0b013e318221b5af
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