FACADE

Why is this trial needed?

Cervical radiculopathy syndrome (CRS), or radiating arm pain caused by cervical nerve root irritation, is a common complaint in otherwise healthy working-age individuals, with an annual incidence of approximately 0.8 per 1,000 inhabitants. While conservative treatment is an effective option for most patients, as symptoms are often intermittent and improve over time, a considerable proportion experience persistent symptoms severe enough to justify neurosurgical intervention.

Anterior cervical discectomy and fusion (ACDF) remains the most widely used surgical technique. Despite the growing adoption of outpatient ACDF procedures, no randomized trial had previously compared outpatient care with conventional inpatient care, particularly focusing on patients’ perceptions of recovery, return to daily activities and work, and safety.

What is the primary objective of the FACADE trial?

We hypothesized that with modern surgical techniques, outpatient ACDF (same-day discharge within 6–8 hours after surgery) would not be inferior to inpatient care in terms of functional recovery, measured by patient-reported outcomes. Additionally, we expected that outpatient care would lead to earlier perceived recovery and encourage faster return to usual daily activities and work.

Where are we now?

Patient recruitment and follow-up have been completed. The trial protocol and primary results have been published.

Key findings

In this pragmatic, randomized, non-inferiority trial of 200 patients undergoing ACDF, outpatient care was not inferior to inpatient care regarding improvement in Neck Disability Index scores at both 6 weeks and 3 months postoperatively. Outpatient treatment was associated with earlier self-reported return to normal activities without compromising safety.

• Trial Protocol: Lönnrot et al., BMJ Open 2019
• Primary Results: Lönnrot et al., JAMA Network Open 2024

Current status‍

Active – outcome reporting ongoing.

Project team

Maarit Tuomisto, Clinical research coordinator

Pirjo Toivonen, Research manager

Marja Silvasti-Lundell, Jarno Satopää, Johannes Förster, Anniina Koski-Palken, Janek Frantzen, Ville Leinonen, Behnam Rezai-Jahromi

Contributors

Operating surgeons:

Miikka Korja, Jussi Antinheimo, Leena Kivipelto, Matti Seppälä, Kimmo Lönnrot

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