Jiang Lianghai, Tan Mingsheng, Dong Liang, Yang Feng, Yi Ping, Tang Xiangsheng, Hao Qingying
*Department of Orthopedics Surgery, China-Japan Friendship Hospital †Graduate School of Peking Union Medical College, Beijing, People's Republic of China.
J Spinal Disord Tech. 2015 Oct;28(8):282-90. doi: 10.1097/BSD.0000000000000317.
Systematic review and meta-analysis.
To evaluate anterior decompression and fusion compared with posterior laminoplasty when treating multilevel cervical compressive myelopathy.
Satisfactory results have been reported with both anterior decompression and fusion and posterior laminoplasty in the treatment of multilevel cervical compressive myelopathy. However, which method is safer and more effective remains controversial.
MEDLINE, EMASE, and the Cochrane library databases were searched for relevant controlled studies up to December 2014 that compared anterior decompression and fusion with posterior laminoplasty for the treatment of multilevel cervical compressive myelopathy. The following outcome measures were extracted for analysis: preoperative and postoperative Japanese Orthopedic Association scores, neurological recovery rate, preoperative and postoperative overall Cobb angle, blood loss, operative time, surgical complications, and reoperation rate.
A total of 19 studies representing 1279 patients were included in this analysis. The results indicated that anterior decompression and fusion was associated with better postoperative neurological function (P=0.001), a higher recovery rate (P<0.01), and better cervical alignment (P<0.01) than posterior laminoplasty in the treatment of multilevel cervical compressive myelopathy. However, anterior decompression and fusion was also associated with higher postoperative complication (P<0.01) and reoperation (P<0.01) rates. Intraoperative blood loss (P<0.01) was higher and operative times (P<0.01) were longer in the anterior decompression and fusion group compared with the posterior laminoplasty group.
On the basis of this meta-analysis, anterior decompression and fusion is associated with better recovery of neurological function, better postoperative cervical alignment, higher postoperative complication and reoperation rates, more blood loss, and longer operative times compared with posterior laminoplasty.
系统评价与荟萃分析。
评估前路减压融合术与后路椎板成形术治疗多节段颈椎压迫性脊髓病的效果。
前路减压融合术和后路椎板成形术治疗多节段颈椎压迫性脊髓病均有满意疗效。然而，哪种方法更安全、更有效仍存在争议。
检索MEDLINE、EMASE和Cochrane图书馆数据库，查找截至2014年12月比较前路减压融合术与后路椎板成形术治疗多节段颈椎压迫性脊髓病的相关对照研究。提取以下结局指标进行分析：术前和术后日本矫形外科学会评分、神经恢复率、术前和术后整体Cobb角、失血量、手术时间、手术并发症和再次手术率。
本分析共纳入19项研究，涉及1279例患者。结果表明，在治疗多节段颈椎压迫性脊髓病方面，前路减压融合术与后路椎板成形术相比，术后神经功能更好（P = 0.001）、恢复率更高（P < 0.01）、颈椎对线更好（P < 0.01）。然而，前路减压融合术术后并发症（P < 0.01）和再次手术率（P < 0.01）也更高。与后路椎板成形术组相比，前路减压融合术组术中失血量更多（P < 0.01），手术时间更长（P < 0.01）。
基于这项荟萃分析，与后路椎板成形术相比，前路减压融合术神经功能恢复更好、术后颈椎对线更好，但术后并发症和再次手术率更高，失血量更多，手术时间更长。
