Cervical Degenerative Disease Treatment: A Systematic Review

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.