C3 laminectomy versus C3 laminoplasty for treating multi-segment cervical spondylotic myelopathy: a meta-analysis

doi:10.3969/j.issn.2095-4344.1218

Abstract

Abstract:

BACKGROUND: There are few objective evaluations concerning efficacy of C₃ laminectomy versus C₃ laminoplasty in posterior cervical expansive open-door laminoplasty and their effects on cervical function.

OBJECTIVE: To systematically evaluate the efficacy of C₃ laminectomy versus C₃ laminoplasty in posterior cervical expansive open-door laminoplasty for treating multi-segment cervical spondylotic myelopathy.

METHODS: Databases of Cochrane Central, PubMed, EMbase, the ISI Web of Knowledge Database, CNKI, CBM, VIP and WanFang were searched for the articles published before July 1, 2018. Randomized or non-randomized controlled trails that compared the efficacy of C₃laminectomy and C₃ laminoplasty for treating multi-segment cervical spondylotic myelopathy were included. Meta-analyses were performed on RevMan 5.2 software provided by Cochrane Collaboration.

RESULTS AND CONCLUSION: (1) Five studies involving 316 patients were included. Among the patients, 146 underwent C₃ laminectomy and 170 underwent C₃ laminoplasty. (2) The results of meta-analysis showed that: compared with C₃ laminoplasty, C₃ laminectomy had higher cervical range of motion [SMD=-5.89, 95%CI (-7.25, -4.70), P < 0.05], and lower incidence of axial symptoms [SMD=-0.23, 95%CI (0.12, 0.46), P < 0.05]. (3) There was no significant difference between two groups in the postoperative Japanese Orthopeadic Association score [SMD=-0.02, 95%CI (-0.55, 0.51), P=0.95 > 0.05]. (4) These results imply that posterior cervical laminoplasty for treating cervical spondylotic using C3 laminectomy and laminoplasty can obtain good clinical outcomes. However, laminectomy can prevent loss of cervical range of motion and reduce the incidence of axial symptoms.

Key words: cervical spondylosis, laminectomy, laminoplasty, expansive laminoplasty, axial symptoms, cervical range of motion, neurological function, meta-analysis

CLC Number:

R459.9

Chang Jianzhong, Xiao Wei, Jin Qi, Sun Chengjun, Zhou Yichi, Zhao Zufa, Mao Xiaobing. C₃ laminectomy versus C₃laminoplasty for treating multi-segment cervical spondylotic myelopathy: a meta-analysis [J]. Chinese Journal of Tissue Engineering Research, 2019, 23(16): 2608-2613.

Figures/Tables 2

2.1 纳入文献的一般情况共检出相关文献174篇，其中中文27篇，英文147篇。利用软件识别并剔除重复发表文献6篇，通过阅读文题和摘要，剔除明显不符合纳入标准的文献149篇。随后经仔细阅读全文和进行质量评价，进一步剔除不合格的文献14篇，最终纳入合格文献5篇。从纳入5篇文献中提取316例病例进行Meta分析，其中C3椎板切除组146例，C3椎板成形组170例。5篇文章均为对比C3椎板切除与C3椎板成形用于颈椎后路椎管扩大成形术的临床对照试验，其中4篇文献为C3全椎板切除[6，9，11-12]，1篇则是根据MRI提示C2/3处是否存在神经压迫而选择C3椎板全切或是部分切除[10]。 2.2 Meta分析结果 2.2.1 术后颈椎活动度 4个研究报道了术后随访截止点颈椎的活动度[9-12]，其中C3椎板切除组106例，C3椎板成形组154例，见图2。数据合并后评估显示C3椎板切除组颈椎活动度大于C3椎板成形组，但差异无显著性意义[SMD=3.72，95%CI(-2.46，9.90)，P=0.24> 0.05]，异质性明显(P < 0.05，I2=92%)。 2.2.2 术后颈椎活动度丢失 3个研究报道了术后随访截止点颈椎活动度的丢失率[9-10，12]，其中C3椎板切除组79例，C3椎板成形组115例，见图3。合并后评估显示C3椎板切除组颈椎活动度丢失小于C3椎板成形组，差异有显著性意义[SMD=-5.98，95%CI(-7.25，-4.70)，P < 0.05]，异质性不明显(P=0.58> 0.05，I2=0%)。 2.2.3 术后轴性症状发生率 3个研究报道了术后轴性症状发生的例数[6，9-10]，包括C3椎板切除组和C3椎板成形组各105例，见图4。合并后评估显示C3椎板切除组轴性症状发生例数小于C3椎板成形组，差异有显著性意义[SMD=0.23，95%CI(0.12，0.46)，P < 0.05]，异质性不明显(P=0.64 > 0.05，I2=0%)。 2.2.4 术前日本骨科协会评分 5个研究中均比较了术前日本骨科协会评分[6，9-12]，包括C3椎板切除组146例，C3椎板成形组170例，见图5。各研究间无异质性(P=0.48>0.05，I2=0%)。Meta分析结果显示，2组差异无显著性意义[SMD=0.55，95%CI(-0.06，1.15)，P=0.08> 0.05]，说明2组术前神经功能相似。"

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C₃ laminectomy versus C₃laminoplasty for treating multi-segment cervical spondylotic myelopathy: a meta-analysis

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