BACKGROUND: In China, although microscope-assisted anterior cervical decompression has
been performed by many spine surgeons in recent years, the application of
microscope still needs to be further promoted in China. Therefore, it is
necessary to systematically evaluate and analyze the clinical efficacy of
cervical spondylopathy by comparing patients under microscope-assisted anterior
cervical approach to traditional anterior cervical approach. As a result, it
can provide the evidence for clinical decision in these cervical spondylopathy
patients.
OBJECTIVE: To systematically evaluate the effect
between microscope-assisted anterior cervical approach and traditional anterior
cervical approach in cervical spondylopathy patients.
METHODS: Databases such as Medline, Embase,
PubMed, Web of science, CBM, Wangfang databases, VIP, and CNKI were searched
from inception to July 2019 to find literature related to microscope-assisted
anterior cervical approach and traditional anterior cervical approach in
treatment of cervical spondylopathy. Two investigators evaluated the researches
independently and compared the operative time, intraoperative blood loss, the
preoperative and postoperative Japanese Orthopedic Association score,
neurological success rate, the preoperative and the postoperative visual
analogue scale score, and the complication rates between two groups. The
quality of the included literature was evaluated by the modified Jadad scale,
the modified Newcastle Ottawa score and the methodological index for
non-randomized-studies. The correlative clinical outcome in inclusive research
was analyzed systematically by using Stata 12.0 Software.
RESULTS AND CONCLUSION: (1) Twelve studies were
accorded with the inclusion criteria, containing 892 cases (438 cases in the
microscope-assisted group, while 454 cases in the traditional group). (2) There
were no significant differences in the preoperative Japanese Orthopedic
Association score (WMD=-0.100, 95%CI(-0.459, 0.259), P=0.585),
operative time (WMD=6.852, 95%CI(-0.446, 14.149), P=0.066),
the preoperative and postoperative visual analogue scale score (WMD=0.293, 95%CI(-0.023,
0.608), P=0.069; WMD=-0.718,
95%CI(-1.495, 0.059), P=0.070)
between two groups. (3) Postoperative Japanese Orthopedic Association score (WMD=1.310, 95%CI(0.621, 1.998), P <
0.001), the rate of neurological success (WMD=4.639,
95%CI(0.294, 8.984), P=0.036) in the microscope-assisted
group were higher than those in the traditional group. The intraoperative blood
loss (WMD=-18.068, 95%CI(-24.504, -11.632), P < 0.001) and the rate of
complication (RR=1.068, 95%CI(1.012, 1.126), P=0.002) in the microscope-assisted group were significantly lower
than those in the traditional group. (4) Performing anterior cervical approach
under microscope has a better clinical effect than using traditional anterior
cervical approach in the treatment of cervical spondylopathy, but more
high-quality clinical studies are needed to verify it.