Meta-analysis of adverse events between anterior and posterior fusion surgery for multiple-level cervical spondylosis

doi:10.12307/2021.281

Abstract

Abstract: OBJECTIVE: The best surgical method for the treatment of multi-segment cervical spondylotic myelopathy is still controversial. In recent years, the application of posterior laminectomy/laminaplasty and fusion in the treatment of cervical spondylotic myelopathy has gradually increased. However, few comprehensive studies have compared the incidence of postoperative adverse events between anterior decompression and fusion and posterior laminectomy/laminaplasty and fusion. Therefore, we conducted a meta-analysis to observe the difference in postoperative adverse events of anterior and posterior cervical fusion for multiple-level cervical spondylosis.
METHODS: PubMed, EMbase, Medline, The Cochrane Library, CBM, CNKI, and Wanfang Database were searched by computer for randomized controlled trials published before March 1, 2020 regarding anterior decompression and fusion and posterior laminectomy/laminaplasty and fusion for the treatment of multiple-level cervical spondylosis. The methodological quality of the included literature was evaluated using NOS scale, and then meta-analysis was performed using RevMan 5.3. Various adverse events were compared to evaluate the difference between anterior and posterior depression fusion surgery in various adverse events.
RESULTS: (1) Two prospective cohort studies and nine retrospective cohort studies were included, with a total of 36 862 patients. The NOS quality assessment was above 5 points. (2) There was no significant difference between the two surgical methods in adverse events such as fixation failure and mortality (P > 0.05). (3) The incidence of new nerve dysfunction (OR=2.68, 95%CI:1.98-3.63, P < 0.000 01), incidence of cerebral fluid leakage (OR=1.73, 95%CI:1.18-2.54, P=0.005), infection rate at surgical site (OR=4.01, 95%CI:1.66-9.72, P=0.002), incidence of axial cervical pain (OR=7.27, 95%CI:3.04-17.40, P < 0.000 01), incidence of revision surgery (RR=3.14, 95%CI:2.80-3.15, P < 0.000 01), and incidence of chronic neck pain (OR=3.60, 95%CI:2.48-5.24, P < 0.000 01) were higher in the posterior laminectomy/laminaplasty and fusion group than those in the anterior decompression and fusion group. (4) The incidence of dysphagia and hoarseness was higher in the anterior decompression and fusion group than that in the posterior laminectomy/laminaplasty and fusion group (OR=0.23, 95%CI:0.12-0.42, P < 0.000 01).
CONCLUSION: (1) Evidence from 11 cohort studies showed that regarding the incidence of postoperative adverse events, the incidences of new neurological dysfunction, cerebrospinal fluid leakage, surgical site infection, cervical axial pain, and revision surgery were less after anterior decompression and fusion. Dysphagia and hoarsenes were less after posterior laminectomy/laminaplasty and fusion. (2) However, limited by the quality of the included literature, above conclusions need to be validated by high-quality, multicenter and blinded randomized controlled trials.

Key words: cervical vertebrae, spinal column, cervical spondylosis, spinal cord compression, spinal fusion, cohort study, adverse events, meta-analysis

CLC Number:

Wang Shuguang, Cai Tongchuan, Feng Xinmin, Nan Liping, Wang Feng, Zhu Lei, Chen Dong, Zhang Liang. Meta-analysis of adverse events between anterior and posterior fusion surgery for multiple-level cervical spondylosis[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(30): 4907-4914.

Figures/Tables 14

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