• Marienke van Middelkoop, Sidney M Rubinstein, Raymond Ostelo, Maurits W van Tulder, Wilco Peul, Bart W Koes, and Arianne P Verhagen.
• Department of General Practice, Erasmus MC, University Medical Center Rotterdam, PO BOX 2040, 3000 CA, Rotterdam, The Netherlands.
• Eur Spine J. 2013 Jan 1;22(1):87-95.

ObjectiveGeneral practitioners refer patients with continued neck pain that do not respond well to conservative care frequently to secondary care for further assessment. Are surgical interventions to the cervical spine effective when compared to conservative care for patients with neck pain?DesignSystematic review.MethodThe search strategy outlined by the Cochrane Back Review Group (CBRG) was followed. The primary search was conducted in MEDLINE, EMBASE, CINAHL, CENTRAL, and PEDro up to June 2011. Randomised controlled trials (RCTs) and controlled clinical trials (CCTs) of adults with neck pain, which evaluated at least one clinically relevant primary outcome measure (e.g. pain, functional status, recovery), were included. In addition, treatments had to include surgery and conservative care. Two authors independently assessed risk of bias using the criteria recommended by the CBRG and extracted the data. The quality of the evidence was rated using the GRADE method.ResultsPatients included had neck pain with or without radiculopathy or myelopathy. In total, three RCTs and six CCTs were identified comparing different surgical interventions with conservative care, of which one had a low risk of bias. Overall there is very low quality of evidence available on the effectiveness of surgery compared to conservative care in neck pain patients showing overall no differences.ConclusionMost studies on surgical techniques comparing these to conservative care showed a high risk of bias. The benefit of surgery over conservative care is not clearly demonstrated.

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