Is Anterior Cervical Discectomy and Fusion Superior to Corpectomy and Fusion for Treatment of Multilevel Cervical Spondylotic Myelopathy A Systemic Review and Meta-AnalysisReportar como inadecuado




Is Anterior Cervical Discectomy and Fusion Superior to Corpectomy and Fusion for Treatment of Multilevel Cervical Spondylotic Myelopathy A Systemic Review and Meta-Analysis - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Objective

Both anterior cervical discectomy with fusion ACDF and anterior cervical corpectomy with fusion ACCF are used to treat cervical spondylotic myelopathy CSM, however, there is considerable controversy as to whether ACDF or ACCF is the optimal treatment for this condition. To compare the clinical outcomes, complications, and surgical trauma between ACDF and ACCF for the treatment of CSM, we conducted a meta-analysis.

Methods

We conducted a comprehensive search in MEDLINE, EMBASE, PubMed, Google Scholar and Cochrane databases, searching for relevant controlled trials up to July 2013 that compared ACDF and ACCF for the treatment of CSM. We performed title and abstract screening and full-text screening independently and in duplicate. A random effects model was used for heterogeneous data; otherwise, a fixed effect model was used to pool data, using mean difference MD for continuous outcomes and odds ratio OR for dichotomous outcomes.

Results

Of 2157 citations examined, 15 articles representing 1372 participants were eligible. Overall, there were significant differences between the two treatment groups for hospital stay M = −5.60, 95% CI = −7.09 to −4.11, blood loss MD = −151.35, 95% CI = −253.22 to −49.48, complications OR = 0.50, 95% CI = 0.35 to 0.73 and increased lordosis of C2–C7 MD = 3.70, 95% CI = 0.96 to 6.45 and fusion segments angles MD = 3.38, 95% CI = 2.54 to 4.22. However, there were no significant differences in the operation time MD = −9.34, 95% CI = −42.99 to 24.31, JOA MD = 0.24, 95% CI = −0.10 to 0.57, VAS MD = −0.06, 95% CI = −0.81 to 0.70, NDI MD = −1.37, 95% CI  = −3.17 to 0.43, Odom criteria OR = 0.88, 95% CI = 0.60 to 1.30 or fusion rate OR = 1.17, 95% CI = 0.34 to 4.11.

Conclusions

Based on this meta-analysis, although complications and increased lordosis are significantly better in the ACDF group, there is no strong evidence to support the routine use of ACDF over ACCF in CSM.



Autor: Ying-Chao Han , Zhu-Qing Liu , Shan-Jin Wang , Li-Jun Li, Jun Tan

Fuente: http://plos.srce.hr/



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