Is Spinal Surgery for Neck Pain Effective?

The third of three reviews of research on spinal surgery for neck pain was recently published by a group of well-known pain experts (van Middelkoop, et al., 2012; van Middelkoop, et al., 2013; Verhagen, et al., 2013). The investigators undertook the reviews of the research on different aspects of neck surgery because the most recent previous studies, done as Cochrane reviews (Fouyas, et al., 2002; Nikolaidis, et al., 2008), were now outdated. So, they systematically reviewed the latest published research on different types of spinal surgery for neck pain to determine whether and how such surgeries are effective. What they found was that spinal surgery for neck pain is not any more effective than other, less invasive, therapies.

Moreover, they found that the published clinical trials on surgeries for neck pain commonly suffered from poor quality research methods and/or a high risk of bias that might skew the results towards surgery. These latest reviews echo the earlier Cochrane reviews of the research. The Cochrane reviews also found that spinal surgery for neck pain is no more effective than other therapies.

Taken altogether, we now have about two decades of scientific research showing that spinal surgery for neck pain adds no value over less invasive therapies.

Specifically, here’s what they found:

• Regardless of type of surgery or technique, spinal surgery for neck pain is no more effective than less invasive, non-surgical therapies for neck pain (Middelkoop, et al., 2012).
• Fusion surgery is not more effective than other spinal surgeries that do not involve fusion (Middelkoop, et al., 2013).
• Fusion with artificial discs provides no clinically significant benefit over other types of fusion surgery (Verhagen, et al., 2013).
• There is no one type of spinal surgery for neck pain that is especially better than any other type (Verhagen, et al., 2013).

These findings are important because spinal surgery for neck pain is by no means a benign treatment. Such surgeries are apt to have higher and more significant rates of complications, relative to less invasive treatments of at least equal therapeutic value. They are also significantly more expensive. As such, these findings might give providers and patients pause before pursuing spinal surgeries for neck pain.

Interestingly, however, the accumulation of this research over the years has not provided any pause to the exponential increases in the rates of spinal surgeries for neck pain (Davis, 1994; Marawar, et al., 2010).

References

Davis, H. (1994). Increasing rates of cervical and lumbar spine surgery in the United States, 1979-1990. Spine, 19(10), 1117-1123.

Fouyas, I. P., Statham, P. F., & Sandercock, P. A. (2002). Cochrane review on the role of surgery in cervical spondylotic radiculomyopathy. Spine, 27(7), 736-747.

Marawar, S., Girardi, F. P., Sama, A. A., Ma, Y. Gaber-Baylis, L. K., Basculides, S. C., & Memtsoudis, S. G. (2010). National trends in anterior cervical fusion procedures. Spine, 35(15), 1454-1459. doi: 10.1097/BRS.0b01381bef3cb

van Middelkoop, M., Rubinstein, S. M., Ostelo, R., van Tulder, M. W., Peul, W., Koes, B. W., & Verhagen, A. P. (2012). Surgery versus conservative care for neck pain: A systematic review. European Spine Journal, 22(1), 87-95. doi: 10.1007/s00586-012-2553-z

van Middelkoop, M., Rubinstein, S. M., Ostelo, R., van Tulder, M. W., Peul, W., Koes, B. W., & Verhagen, A. P. (2013). No additional value of fusion techniques on anterior discectomy for neck pain: A systematic review. Pain, 153, 2167-2173.

Nikolaidis I., Fouyas, I. P., Sandercock, P. A., & Statham, P. F. (Updated December 14, 2008). Surgery for cervical radiculopathy or myelopathy. [Cochrane Review]. In Cochrane Database of Systematic Reviews, 2010 (1).

Verhagen, A. P., van Middelkoop, M, Rubinstein, S. M., Ostelo, R., Jacobs, W., Peul, W., Koes, B. W. van Tulder, M. W. (2013). Effect of various kinds of cervical spinal surgery on clinical outcomes: A systematic review and meta-analysis. Pain, 154, 2388-2396.

Author: Murray J. McAllister, PsyD

Date of Last Modification: 12-8-2013