Liu Xuzhou, Wang Hehui, Zhou Zhilai, Jin Anmin
Orthopedics. 2014 Feb;37(2):e117-22. doi: 10.3928/01477447-20140124-12.
The optimal surgical strategy for anterior or posterior approaches remains controversial for multilevel cervical compressive myelopathy caused by multisegment cervical spondylotic myelopathy (MCSM) or ossification of the posterior longitudinal ligament (OPLL). A systematic review and meta-analysis was conducted evaluating the clinical results of anterior decompression and fusion (ADF) compared with posterior laminoplasty for patients with multilevel cervical compressive myelopathy. PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials and nonrandomized cohort studies conducted from 1990 to May 2013 comparing ADF with posterior laminoplasty for the treatment of multilevel cervical compressive myelopathy due to MCSM or OPLL. The following outcome measures were extracted: Japanese Orthopedic Association (JOA) score, recovery rate, complication rate, reoperation rate, blood loss, and operative time. Subgroup analysis was conducted according to the mean number of surgical segments. Eleven studies were included in the review, all of which were prospective or retrospective cohort studies with relatively low quality indicated by GRADE Working Group assessment. A definitive conclusion could not be reached regarding which surgical approach is more effective for the treatment of multilevel cervical compressive myelopathy. Although ADF was associated with better postoperative neural function than posterior laminoplasty in the treatment of multilevel cervical compressive myelopathy due to MCSM or OPLL, there was no apparent difference in the neural function recovery rate between the 2 approaches. Higher rates of surgery-related complication and reoperation should be taken into consideration when ADF is used for patients with multilevel cervical compressive myelopathy. The surgical trauma associated with corpectomy was significantly higher than that associated with posterior laminoplasty.
对于多节段脊髓型颈椎病（MCSM）或后纵韧带骨化症（OPLL）所致的多节段颈椎压迫性脊髓病，前路或后路手术的最佳策略仍存在争议。我们进行了一项系统评价和荟萃分析，比较了前路减压融合术（ADF）与后路椎板成形术治疗多节段颈椎压迫性脊髓病的临床效果。检索了PubMed、Embase和Cochrane图书馆，查找1990年至2013年5月期间进行的比较ADF与后路椎板成形术治疗因MCSM或OPLL导致的多节段颈椎压迫性脊髓病的随机对照试验和非随机队列研究。提取了以下结局指标：日本骨科协会（JOA）评分、恢复率、并发症发生率、再次手术率、失血量和手术时间。根据手术节段的平均数进行亚组分析。该评价纳入了11项研究，所有这些研究均为前瞻性或回顾性队列研究，根据GRADE工作组评估，质量相对较低。对于哪种手术方法治疗多节段颈椎压迫性脊髓病更有效，无法得出明确结论。尽管在治疗因MCSM或OPLL导致的多节段颈椎压迫性脊髓病时，ADF术后神经功能优于后路椎板成形术，但两种方法的神经功能恢复率并无明显差异。当ADF用于多节段颈椎压迫性脊髓病患者时，应考虑到与手术相关的并发症和再次手术率较高。椎体次全切除术相关的手术创伤明显高于后路椎板成形术。
