Meta-analysis of posterior cervical laminectomy titanium mini-plate versus lateral mass screw fixation for treating multilevel cervical spondylotic myelopathy

doi:10.3969/j.issn.2095-4344.1219

Abstract

Abstract:

BACKGROUND: The main surgical procedures for treating multilevel cervical compressive myelopathy are posterior expansive unilateral open-door laminoplasty with titanium mini-plate and posterior cervical laminectomy with lateral mass screw fixation. However, the superiority of these two methods in clinical practice is still controversial. Relative comparative studies are various, but there is a lack of objective evaluation due to sample size.

OBJECTIVE: To compare the efficacy, safety and postoperative complications of patients with multilevel cervical compressive myelopathy treated by these two procedures, and to further analyze their advantages and disadvantages.

METHODS: CNKI, WanFang, VIP, PubMed, Embase, Cochrane Library and Science Direct databases were searched for the randomized controlled trials or nonrandomized controlled trials concerning posterior expansive unilateral open-door laminoplasty with titanium mini-plate versus posterior cervical laminectomy with lateral mass screw fixation. The following outcome measures were extracted: operation time, intraoperative blood loss, Japanese Orthopaedic Association scores, Visual Analog Scale, cervical curvature index, cervical dysfunction index, C₅ nerve root paralysis, axial symptoms and other complications. Data analysis was conducted on STATA 15.1 software.

RESULTS AND CONCLUSION: (1) A total of 16 studies, involving 1 666 patients. (2) Meta-analysis results showed that in the titanium mini-plate group, the operation time [WMD=-20.090, 95%CI (-27.759, -12.421), P < 0.000 01] and intraoperative blood loss [WMD=-42.519, 95%CI (-66.368, -18.670), P < 0.000 01] were superior to the lateral mass screw group. (3) There were no significant differences in the postoperative Japanese Orthopaedic Association score [WMD=-0.092, 95%CI (-0.177, -0.361), P=0.502 > 0.05], postoperative Visual Analog Scale score [WMD=-0.247, 95%CI (-0.667, 0.172), P=0.248 > 0.05], postoperative cervical curvature index [WMD=-0.314, 95%CI (-1.070, 0.441), P=0.415 > 0.05], and postoperative Cobb angle [WMD=0.193, 95%CI (-0.116, 0.502), P=0.220 > 0.05] between two groups. (4) The postoperative cervical dysfunction index [WMD=-1.361, 95%CI (-2.219, -0.503), P=0.002 < 0.05], axial symptoms [RR=0.572, 95%CI (0.43, 0.759), P < 0.000 01], C₅palsy [RR=0.313, 95%CI (0.211, 0.465), P < 0.000 01] and incidence of total complications [RR=0.521, 95%CI (0.426，0.637), P < 0.000 01] in the titanium mini-plate group were lower than those in the lateral mass screw group. (5) These results suggest that both titanium mini-plate and lateral mass screw obtain good short-term clinical efficacy in the treatment of multilevel cervical compressive myelopathy, and the long-term efficacy remains to be studied further. Compared with lateral mass screw group, the lateral mass screw group has lower incidence of C₅ palsy, axial symptom and total complications, shorter operation time and less blood loss.

Key words: unilateral open-door laminoplasty, lateral mass screw, laminectomy, titanium mini-plate, internal fixation with titanium plate, expansive laminectomy, vertebral plate sagittal diameter, meta-analysis

CLC Number:

R459.9

Wang Wei, Ma Junfeng, Cui Zijian, Zhang Lilong, Jiang Zehua, Lu Yun. Meta-analysis of posterior cervical laminectomy titanium mini-plate versus lateral mass screw fixation for treating multilevel cervical spondylotic myelopathy [J]. Chinese Journal of Tissue Engineering Research, 2019, 23(16): 2614-2624.

Figures/Tables 10

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