CASINO: surgical or nonsurgical treatment for cervical radiculopathy, a randomised controlled trial.
CASINO: surgical or nonsurgical treatment for cervical radiculopathy, a randomised controlled trial.
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DOI：
10.1186/1471-2474-15-129
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发表时间：
2014-04-14
影响因子：
2.3
通讯作者：
Vleggeert-Lankamp C
中科院分区：
文献类型：
--
作者：
van Geest S;Kuijper B;Oterdoom M;van den Hout W;Brand R;Stijnen T;Assendelft P;Koes B;Jacobs W;Peul W;Vleggeert-Lankamp C
椎间盘突出引起的颈神经根综合征（CRS）可以通过脊柱根减压手术安全治疗。在绝大多数情况下，这可以减轻手臂疼痛并恢复功能。然而，保守治疗也有很大的机会缓解症状。本研究的目的是在一年的随访期间评估手术与延长保守治疗的（成本）效益，并评估手术的时机。将评估有利于两种治疗方法之一的易感因素。患有致残性上臂神经根性疼痛，至少2个月且mri证实颈椎间盘突出的患者将被随机分组，接受手术治疗或延长保守治疗，如果需要的话，进行手术治疗。手术干预将是前椎间盘切除术或后椎间孔切开术，这是根据常规护理进行的。手术将在随机分组后2-4周内进行。随机分组后立即开始保守治疗。主要结局指标是随机分组后一年内手臂疼痛或刺痛感的VAS评分。此外，将通过将主要结果与症状持续时间相关联来研究手术时机。次要结果指标包括生活质量、费用和感知恢复。将评估预先确定的预后因素。整个随访期为两年。需要400名患者作为样本。统计分析将使用基于“意向治疗”原则的线性混合模型进行。此外，将为患者开发一种新的CRS问卷，莱顿颈椎神经根综合征功能量表（LCRSF）。结果将有助于更好的决策治疗颈神经根综合征。NTR3504
Cervical radicular syndrome (CRS) due to a herniated disc can be safely treated by surgical decompression of the spinal root. In the vast majority of cases this relieves pain in the arm and restores function. However, conservative treatment also has a high chance on relieving symptoms. The objective of the present study is to evaluate the (cost-) effectiveness of surgery versus prolonged conservative care during one year of follow-up, and to evaluate the timing of surgery. Predisposing factors in favour of one of the two treatments will be evaluated. Patients with disabling radicular arm pain, suffering for at least 2 months, and an MRI-proven herniated cervical disc will be randomised to receive either surgery or prolonged conservative care with surgery if needed. The surgical intervention will be an anterior discectomy or a posterior foraminotomy that is carried out according to usual care. Surgery will take place within 2–4 weeks after randomisation. Conservative care starts immediately after randomisation. The primary outcome measure is the VAS for pain or tingling sensations in the arm one year after randomisation. In addition, timing of surgery will be studied by correlating the primary outcome to the duration of symptoms. Secondary outcome measures encompass quality of life, costs and perceived recovery. Predefined prognostic factors will be evaluated. The total follow-up period will cover two years. A sample size of 400 patients is needed. Statistical analysis will be performed using a linear mixed model which will be based on the ‘intention to treat’ principle. In addition, a new CRS questionnaire for patients will be developed, the Leiden Cervical Radicular Syndrome Functioning (LCRSF) scale. The outcome will contribute to better decision making for the treatment of cervical radicular syndrome. NTR3504
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影响因子：
5.9
作者：
FLOR, H;TURK, DC;BIRBAUMER, N
通讯作者：
BIRBAUMER, N
影响因子：
3.5
作者：
Schellingerhout, Jasper M.;Verhagen, Arianne P.;Heymans, Martijn W.;Koes, Bart W.;de Vet, Henrica C.;Terwee, Caroline B.
通讯作者：
Terwee, Caroline B.
影响因子：
3
作者：
Hacker, RJ;Cauthen, JC;Griffith, SL
通讯作者：
Griffith, SL
影响因子：
3
作者：
Persson, LCG;Carlsson, CA;Carlsson, JY
通讯作者：
Carlsson, JY
影响因子：
3
作者：
Sampath, P;Bendebba, M;Ducker, T
通讯作者：
Ducker, T