Liu Xuzhou, Min Shaoxiong, Zhang Hui, Zhou Zhilai, Wang Hehui, Jin Anmin
Department of Orthopedics Zhujiang Hospital, Southern Medical University, 253 Gongye Road, Guangzhou, 510282, China.
Eur Spine J. 2014 Feb;23(2):362-72. doi: 10.1007/s00586-013-3043-7. Epub 2013 Oct 5.
Surgical strategy for multilevel cervical myelopathy resulting from cervical spondylotic myelopathy (CSM) or ossification of posterior longitudinal ligament (OPLL) still remains controversial. There are still questions about the relative benefit and safety of direct decompression by anterior corpectomy (CORP) versus indirect decompression by posterior laminoplasty (LAMP).
To perform a systematic review and meta-analysis evaluating the results of anterior CORP compared with posterior LAMP for patients with multilevel cervical myelopathy.
Systematic review and meta-analysis of cohort studies comparing anterior CORP with posterior LAMP for the treatment of multilevel cervical myelopathy due to CSM or OPLL from 1990 to December 2012. An extensive search of literature was performed in Pubmed, Embase, and the Cochrane library. The quality of the studies was assessed according to GRADE. The following outcome measures were extracted: pre- and postoperative Japanese orthopedic association (JOA) score, neurological recovery rate (RR), surgical complications, reoperation rate, operation time and blood loss. Two reviewers independently assessed each study for quality and extracted data. Subgroup analysis was conducted according to the mean number of surgical segments.
A total of 12 studies were included in this review, all of which were prospective or retrospective cohort studies with relatively low quality. The results indicated that the mean JOA score system for cervical myelopathy and the neurological RR in the CORP group were superior to those in the LAMP group when the mean surgical segments were <3, but were similar between the two groups in the case of the mean surgical segments equal to 3 or more. There was no statistical difference in the surgical complication rate between the two groups when the mean surgical segments <3, but were significantly higher incidences of surgical complications and complication-related reoperation in the CORP group compared with the LAMP group in the case of the mean surgical segments equal to 3 or more. Besides, the operation time in the CORP group was longer than that in the LAMP group, and the average blood loss was significantly more in the CORP group compared with the LAMP group.
Based on the results above, anterior CORP and fusion is recommended for the treatment of multilevel cervical myelopathy when the involved surgical segments were <3. Given the higher rates of surgical complications and complication-related reoperation and the higher surgical trauma associated with multilevel CORP, however, it is suggested that posterior LAMP may be the preferred method of treatment for multilevel cervical myelopathy when the involved surgical segments were equal to 3 or more. In addition, taking the limitations of this study into consideration, it was still not appropriate to draw a strong conclusion claiming superiority for CORP or LAMP. A well-designed, prospective, randomized controlled trial is necessary to provide objective data on the clinical results of both procedures.
由颈椎病性脊髓病（CSM）或后纵韧带骨化症（OPLL）导致的多节段颈椎脊髓病的手术策略仍存在争议。关于前路椎体次全切除术（CORP）直接减压与后路椎板成形术（LAMP）间接减压的相对益处和安全性仍存在疑问。
进行一项系统评价和荟萃分析，评估多节段颈椎脊髓病患者前路CORP与后路LAMP的治疗结果。
对1990年至2012年12月间比较前路CORP与后路LAMP治疗CSM或OPLL所致多节段颈椎脊髓病的队列研究进行系统评价和荟萃分析。在PubMed、Embase和Cochrane图书馆进行广泛的文献检索。根据GRADE评估研究质量。提取以下结局指标：术前和术后日本骨科协会（JOA）评分、神经恢复率（RR）、手术并发症、再次手术率、手术时间和失血量。两名评价者独立评估每项研究的质量并提取数据。根据手术节段的平均数进行亚组分析。
本评价共纳入12项研究，均为前瞻性或回顾性队列研究，质量相对较低。结果表明，当平均手术节段数<3时，CORP组颈椎脊髓病的平均JOA评分系统和神经RR优于LAMP组，但当平均手术节段数等于3或更多时，两组相似。当平均手术节段数<3时，两组手术并发症发生率无统计学差异，但当平均手术节段数等于3或更多时，CORP组手术并发症及并发症相关再次手术的发生率显著高于LAMP组。此外，CORP组的手术时间长于LAMP组，且CORP组的平均失血量显著多于LAMP组。
基于上述结果，当受累手术节段数<3时，建议采用前路CORP及融合术治疗多节段颈椎脊髓病。然而，鉴于多节段CORP手术并发症及并发症相关再次手术的发生率较高，且手术创伤较大，当受累手术节段数等于3或更多时，建议后路LAMP可能是多节段颈椎脊髓病的首选治疗方法。此外，考虑到本研究的局限性，目前仍不宜得出CORP或LAMP具有优越性的强有力结论。需要进行一项设计良好的前瞻性随机对照试验，以提供两种手术临床结果的客观数据。
