Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Antti Malmivaara, Finnish Institute for Health and Welfare
- Second opponent: Professor Danielle van der Windt, Keele University
- Third member and chair of the evaluation committee: Professor Angelika Gabriele Sorteberg, University of Oslo
Chair of the Defence
Professor II Espen A. Haavardsholm, University of Oslo
Principal Supervisor
Siri Bjorland, Oslo University Hospital
Summary
Limited evidence exists regarding indications for surgical and nonsurgical treatment of cervical radiculopathy. The prognosis is generally favourable regardless of treatment, and the condition is often self-limiting without specific treatment.
The aims of this thesis were to evaluate and compare the effectiveness of surgical and nonsurgical treatment in patients with radiculopathy caused by disc herniation or spondylosis.
Secondary aims were to explore patient expectations to treatment, and to design and describe a nonsurgical treatment that could meet the patients’ needs.
Two randomised controlled trials (RCT), including 180 patients with disabling arm pain and disc herniation or spondylosis proven by magnetic resonance imaging or computed tomography, were conducted from October 2018 to January 2024.
We conducted a cross-sectional study including the first 100 consecutive patients from our RCTs and asked them about their expectations of the treatment outcome.
We also successfully developed a nonsurgical treatment consisting of functional intervention with a cognitive approach based on current recommendations.
The present data demonstrated a statistically significant difference in NDI at 12 months in favour of surgical treatment in the disc herniation trial, but no difference in the spondylosis trial. The difference in the primary outcome was relatively small, even in the disc herniation trial, and may be clinically irrelevant. All patients in the two RCTs achieved improvement from baseline to 12 months, regardless of the treatment they received. Patients with cervical radiculopathy have high expectations to treatment, particularly high for surgery.
The risks and costs of surgery should be weighed against possible benefits in the shared decision-making process when treating patients with cervical radiculopathy. Conservative treatment, including the relevant aspects of our nonsurgical treatment, should be considered before scheduling surgery.
Additional information
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