Nonsurgical versus Surgical Treatment for Cervical Radiculopathy or Myelopathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Purpose There is conflicting evidence regarding the optimal management strategy for cervical radiculopathy and myelopathy. We conducted a meta-analysis to evaluate the relative effectiveness of nonsurgical treatment and surgical care in adult patients with cervical radiculopathy or myelopathy. Methods We systematically searched PubMed, Embase, and the Cochrane Library to identify randomized controlled trials (RCTs) comparing nonsurgical treatment with surgical treatment. All statistical analyses were performed using RevMan version 5.4. Results Six RCTs met the inclusion criteria. Surgical treatment significantly improved neck pain (SMD 0.70, 95% CI 0.15–1.26) and arm pain (SMD 0.62, 95% CI 0.04–1.19) compared with non-surgical care. Subgroup analysis showed that benefits for neck pain were most pronounced in patients with disc herniation (SMD 1.02, 95% CI 0.11–1.93) and in those with unspecified pathology (SMD 1.23, 95% CI 0.69–1.77), whereas benefits for arm pain were observed only in disc herniation (SMD 1.29, 95% CI 0.90–1.68). Surgical treatment also improved physical function in sensitivity analysis (SMD 0.33, 95% CI 0.06–0.59) and emotional/mood outcomes (SMD 0.22, 95% CI 0.02–0.45) but did not significantly affect patient-reported overall improvement (RR 0.97, 95% CI 0.72–1.31) or analgesic use (RR 1.03, 95% CI 0.77–1.36). Conclusions Surgical management of cervical radiculopathy or myelopathy may provide superior improvements in neck and arm pain, as well as functional and emotional outcomes, compared with non-surgical treatment, particularly in patients with disc herniation. Further high-quality trials are warranted to confirm these findings and define optimal patient selection.