Various approaches for multilevel cervical spondylotic myelopathy: a meta-analysis on clinical effectiveness and safety

doi:10.3969/j.issn.2095-4344.2014.04.025

Abstract

Abstract:

BACKGROUND: A large number of studies have confirmed that anterior approach and posterior approach for multilevel cervical spondylotic myelopathy were effective, but there is still no conclusion in which one is better.

OBJECTIVE: To systematically assess the clinical effectiveness and safety of anterior approach versus posterior approach for multilevel cervical spondylotic myelopathy.

METHODS: The databases such as The Cochrane Library (Issue 3, 2013), PubMed (from 1966 to March 2013), OVID (from 1950 to March 2013), EMbase (from 1966 to March 2013), Chinese Biomedical Literature Database (from 1978 to March 2013), WanFang Database (from 1998 to March 2013), China National Knowledge Infrastructure (from 1999 to March 2013) were electronically searched and five relevant journals were searched by hand to collect the randomized controlled trials or non-randomized controlled trials about the clinical effectiveness and safety of anterior approach versus posterior approach for multilevel cervical spondylotic myelopathy. Two reviewers independently screened the literature according to the inclusive and exclusive criteria, extracted the data, and assessed the methodological quality of included studies. Then the meta-analysis was performed by using RevMan5.2 software.

RESULTS AND CONCLUSION: A total of 11 controlled trials involving 814 patients were included. Meta-analysis results showed that, compared with posterior approach, postoperative Japanese Orthopaedic Association scores were better (P < 0.000 01), improvement rate of neurological function was higher (P=0.000 3), the incidence of C₅ root palsy was lower (P=0.007), but operation time was longer (P < 0.000 01), amount of intraoperative bleeding was larger (P=0.000 7), incidence of adjacent segments degeneration was higher (P=0.01), incidence of postoperative complications was higher (P < 0.000 01) and the rate of secondary surgical procedures was higher (P=0.003) after anterior approach. Additionally, there were no differences between the two groups in the cervical range of motion (P=0.56). For quantity limitation and low methodological quality of included studies, this conclusion still needs to be further proved by performing more high-quality and large-scale randomized controlled trials.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: cervical vertebrae, surgical procedures, operative, treatment outcome, Meta-analysis

CLC Number:

R318

Wang Guo-qi, Xu Tao, Sheng Wei-bin, Deng Qiang, Chen Ke-yi, Song Yang, Zhang En-feng. Various approaches for multilevel cervical spondylotic myelopathy: a meta-analysis on clinical effectiveness and safety[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(4): 637-644.

Figures/Tables 4

2.2 Meta分析结果 2.2.1 术后JOA评分 8个研究报道了前路与后路手术的术后JOA评分[9, 11-12, 14, 16-19]，共纳入569例患者，前路手术组299例，后路手术组270例。各研究间无统计学异质性(P=0.18，I2=31%)，采用固定效应模型进行Meta分析。前路手术组的术后JOA评分高于后路手术组，差异有非常显著性意义[WMD=1.08，95% CI(0.68，1.47)，P < 0.000 01](图1)。 2.2.2 神经功能改善率 6个研究报道了前路与后路手术的神经功能改善率[9, 12, 14-15, 17, 19]，共纳入543例患者，前路手术组291例，后路手术组252例。各研究间无统计学异质性(P = 0.13，I2= 41%)，采用固定效应模型进行Meta分析。前路手术组的神经功能改善率高于后路手术组，差异有显著性意义[WMD=9.04，95% CI (4.13，13.94)，P= 0.000 3] (图2)。 2.2.3 并发症发生率 9个研究报道了前路与后路手术的并发症发生率[10-16, 18-19]，共纳入608例患者，前路手术组296例，后路手术组312例。各研究间无统计学异质性(P = 0.19，I2= 28%)，采用固定效应模型进行Meta分析。前路手术组的并发症发生率高于后路手术组，差异有显著性意义[OR = 2.72，95% CI(1.76，4.19)，P < 0.000 01] (图3)。 2.2.4 邻近节段退变 4个研究报道了前路与后路手术的邻近节段退变[10, 14, 16, 19]，共纳入208例患者，前路手术组102例，后路手术组106例。各研究间无统计学异质性(P= 0.91，I2= 0%)，采用固定效应模型进行Meta分析。前路手术组的邻近节段退变发生率高于后路手术组，差异有显著性意义[OR=6.01，95% CI(1.47，24.54)，P=0.01](图4)。 2.2.5 颈椎活动度 3个研究报道了前路与后路手术的颈椎活动度[12, 14-15]，共纳入254例患者，前路手术组128例，后路手术组126例。各研究间有统计学异质性(P < 0.000 01，I2= 99%)，采用随机效应模型进行Meta分析。前路手术组与后路手术组术后颈椎活动度比较差异无显著性意义[WMD=3.08，95%CI(-7.28，13.44)，P=0.56](图5)。 2.2.6 C5神经根麻痹发生率 5个研究报道了前路与后路手术的C5神经根麻痹发生率[11-12, 14, 16, 19]，共纳入318例患者，前路手术组156例，后路手术组162例。各研究间无统计学异质性(P=0.96，I2=0%)，采用固定效应模型进行Meta分析。前路手术组的术后C5神经根麻痹发生率低于后路手术组，差异有显著性意义[OR = 0.20，95% CI(0.06，0.64)，P=0.007](图6)。 2.2.7 再手术率 5个研究报道了前路与后路手术的再手术率[10, 12-14, 16]，共纳入314例患者，前路手术组142例，后路手术组172例。各研究间无统计学异质性(P=0.39，I2= 3%)，采用固定效应模型进行Meta分析。结果显示，前路手术组的再手术率高于后路手术组，差异有显著性意义[OR=3.90，95%CI(1.59，9.54)，P=0.003] (图7)。 2.2.8 手术时间 4个研究报道了前路与后路手术的手术时间[12-13, 15-16]，共纳入352例患者，前路手术组168例，后路手术组184例。各研究间无统计学异质性(P=0.28，I2= 21%)，采用固定效应模型进行Meta分析。前路手术组的手术时间高于后路手术组，差异有显著性意义[WMD=61.30，95%CI(52.33，70.28)，P < 0.000 01] (图8)。 2.2.9 术中出血量 3个研究报道了前路与后路手术的术中出血量[12-13，16]，共纳入236例患者，前路手术组104例，后路手术组132例。各研究间统计学异质性较小(P=0.12，I2=54%)，采用固定效应模型进行Meta分析。前路手术组的术中出血量高于后路手术组，差异有显著性意义[WMD = 150.02，95%CI(63.46，236.59)，P=0.000 7] (图9)。 "

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