European Spine Journal

, Volume 17, Supplement 1, pp 153–169

Treatment of Neck Pain

Injections and Surgical Interventions: Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders
  • Eugene J. Carragee
  • Eric L. Hurwitz
  • Ivan Cheng
  • Linda J. Carroll
  • Margareta Nordin
  • Jaime Guzman
  • Paul Peloso
  • Lena W. Holm
  • Pierre Côthé
  • Sheilah Hogg-Johnson
  • Gabrielle van der Velde
  • J. David Cassidy
  • Scott Haldeman
Best Evidence

DOI: 10.1007/s00586-008-0632-y

Cite this article as:
Carragee, E.J., Hurwitz, E.L., Cheng, I. et al. Eur Spine J (2008) 17(Suppl 1): 153. doi:10.1007/s00586-008-0632-y

Study Design

Best evidence synthesis.

Objective

To identify, critically appraise, and synthesize literature from 1980 through 2006 on surgical interventions for neck pain alone or with radicular pain in the absence of serious pathologic disease.

Summary of Background Data

There have been no comprehensive systematic literature or evidence-based reviews published on this topic.

Methods

We systematically searched Medline for literature published from 1980 to 2006 on percutaneous and open surgical interventions for neck pain. Publications on the topic were also solicited from experts in the field. Consensus decisions were made about the scientific merit of each article; those judged to have adequate internal validity were included in our Best Evidence Synthesis.

Results

Of the 31,878 articles screened, 1203 studies were relevant to the Neck Pain Task Force mandate and of these, 31 regarding treatment by surgery or injections were accepted as scientifically admissible. Radiofrequency neurotomy, cervical facet injections, cervical fusion and cervical arthroplasty for neck pain without radiculopathy are not supported by current evidence. We found there is support for short-term symptomatic improvement of radicular symptoms with epidural corticosteroids. It is not clear from the evidence that long-term out comes are improved with the surgical treatment of cervical radiculopathy compared to non operative measures. However, relatively rapid and substantial symptomatic relief after surgical treatment seems to be reliably achieved. It is not evident that one open surgical technique is clearly superior to others for radiculopathy. Cervical foramenal or epidural injections are associated with relatively frequent minor adverse events (5%–20%); however, serious adverse events are very uncommon (<1%). After open surgical procedures on the cervical spine, potentially serious acute complications are seen in approximately 4% of patients.

Conclusion

Surgical treatment and limited injection procedures for cervical radicular symptoms may be reasonably considered in patients with severe impairments. Percutaneous and open surgical treatment for neck pain alone, without radicular symptoms or clear serious pathology, seems to lack scientific support.

Keywords

best evidence synthesis surgery injections cervical spine neck pain whiplash-associated disorder radiculopathy 

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Eugene J. Carragee
    • 1
  • Eric L. Hurwitz
    • 2
  • Ivan Cheng
    • 3
  • Linda J. Carroll
    • 4
  • Margareta Nordin
    • 5
    • 6
  • Jaime Guzman
    • 7
    • 8
  • Paul Peloso
    • 9
  • Lena W. Holm
    • 10
  • Pierre Côthé
    • 11
    • 12
    • 13
    • 14
  • Sheilah Hogg-Johnson
    • 13
    • 15
  • Gabrielle van der Velde
    • 13
    • 16
  • J. David Cassidy
    • 15
    • 17
  • Scott Haldeman
    • 18
    • 19
  1. 1.Department of Orthopaedic Surgery, Stanford University School of Medicine; Orthopaedic Spine Center and Spinal Surgery ServiceStanford University Hospital and ClinicsStanfordUSA
  2. 2.Department of Public Health Sciences, John A. Burns School of MedicineUniversity of Hawaii at MānoaHonoluluUSA
  3. 3.Department of Orthopaedic SurgeryStanford University School of MedicineStanfordUSA
  4. 4.Department of Public Health Sciences, and the Alberta Centre for Injury Control and Research, School of Public HealthUniversity of AlbertaEdmontonCanada
  5. 5.Departments of Orthopaedics and Environmental Medicine and Program of Ergonomics and Biomechanics, School of Medicine and Graduate School of Arts and ScienceNew York UniversityNew YorkUSA
  6. 6.Occupational and Industrial Orthopaedic Center (OIOC)New York University Medical CenterNew YorkUSA
  7. 7.Department of MedicineUniversity of British ColumbiaVancouverCanada
  8. 8.Occupational Health and Safety Agency for Healthcare in British ColumbiaVancouverCanada
  9. 9.Endocrinology, Analgesia and InflammationMerck & Co.RahwayUSA
  10. 10.Institute of Environmental MedicineKarolinska InstitutetStockholmSweden
  11. 11.Departments of Public Health Sciences and Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada
  12. 12.Centre of Research Expertise in Improved Disability Outcomes (CREIDO)University Health Network Rehabilitation Solutions, Toronto Western HospitalTorontoCanada
  13. 13.Institute for Work and HealthTorontoCanada
  14. 14.Division of Health Care and Outcomes ResearchToronto Western Research InstituteTorontoCanada
  15. 15.Department of Public Health SciencesUniversity of TorontoTorontoCanada
  16. 16.Department of Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada
  17. 17.Division of Health Care and Outcomes Research, Toronto Western Research InstituteUniversity Health NetworkTorontoCanada
  18. 18.Department of NeurologyUniversity of CaliforniaIrvineUSA
  19. 19.Department of Epidemiology, School of Public HealthUniversity of CaliforniaLos AngelesUSA