Non-operative Management is Associated With Similar Long-Term Patient-Reported Outcomes Compared to Surgery for Cervical Radiculopathy

STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: To compare long-term patient-reported outcomes between surgical and non-operative management for cervical radiculopathy. SUMMARY OF BACKGROUND DATA: Cervical radiculopathy is a common condition associated with substantial morbidity. While both surgical and non-operative approaches are effective, it remains unclear which patients benefit most from each strategy and whether earlier operative intervention confers meaningful long-term advantage. METHODS: PubMed, Embase and the Cochrane Library were searched from inception to January 2026 for randomized and observational studies comparing surgical and non-operative management for cervical radiculopathy. Primary outcomes included visual analog scale (VAS) scores for neck and arm pain, neck disability index (NDI), and overall clinical success. Secondary outcomes included analgesia use and sick leave. Random-effects meta-analyses were performed using restricted maximum likelihood estimation. Risk of bias was assessed using RoB 2 and ROBINS-I, and certainty of evidence using GRADE. RESULTS: Twelve studies comprising 1127 patients (surgical: 487; non-operative: 640) were included. Surgery was not associated with superior outcomes in VAS for arm pain (MD -0.61, 95% CI -1.46-0.24, P=0.16), VAS for neck pain (MD -0.09, 95% CI -0.31-0.14, P=0.44), or NDI (MD -1.85, 95% CI -4.18-0.48, P=0.52) after 12 months of treatment, nor in overall success (RR 1.05, 95% CI 0.94-1.16, P=0.30). No significant differences were observed in analgesia use (P=0.57) or sick leave (P=0.36) at last follow-up. Most studies were rated serious risk of bias and overall certainty of evidence was moderate. CONCLUSION: Evidence from this pooled analysis suggests long-term pain, disability, and functional outcomes are comparable between patients selected for non-operative management and those selected for surgery. These findings reflect outcomes within selected cohorts and should not be interpreted as evidence of therapeutic equivalence. LEVEL OF EVIDENCE: II.