颈椎神经根病的手术治疗：随机对照试验的荟萃分析。

Surgical Treatment of Cervical Radiculopathy: Meta-analysis of Randomized Controlled Trials.

机构信息

Department of Neurosurgery, Jewish General Hospital, Montreal, Quebec, Canada.

Department of Neurosurgery, McGill University, Montreal, Quebec, Canada.

出版信息

Spine (Phila Pa 1976). 2018 Mar 15;43(6):E365-E372. doi: 10.1097/BRS.0000000000002324.

DOI:10.1097/BRS.0000000000002324

PMID:28700452

Abstract

STUDY DESIGN

Meta-analysis of published randomized controlled trials (RCTs).

OBJECTIVE

To determine whether anterior cervical discectomy and fusion (ACDF), cervical disc replacement (CDR), or minimally invasive posterior cervical foraminotomy (MI-PCF) provides the best outcomes for patients with symptomatic single-level, single-side, and cervical radiculopathy.

SUMMARY OF BACKGROUND DATA

The surgical treatment of cervical radiculopathy is still controversial. ACDF has been widely used as a "gold standard." CDR has evolved and become a motion-preserving alternative with a potentially lower incidence of adjacent segment disease. However, both techniques require anterior neck dissection that carries a potential for serious morbidity. MI-PCF is a motion-preserving technique that can be performed with minimal invasiveness but has not gained universal acceptance.

METHODS

Electronic database search for RCTs comparing the efficacy and effectiveness of ACDF, CDR, and MI-PCF was performed. Meta-analysis was done for secondary surgical procedures and adverse events.

RESULTS

A total of 358 studies were retrieved, of which four RCT reports met the inclusion criteria for this study. Three studies present clinical data comparing ACDF and CDR, and one study presents data comparing ACDF and MI-PCF. Available data from the RCTs analyzed concluded that ACDF, CDR, and MI-PCF result in significant improvements in relevant symptoms, clinical, and functional outcomes in patients with single-level, single side cervical radiculopathy refractory to nonoperative treatment. CDR had the lowest percentage of secondary surgical procedures (P = 0.0178) whereas MICPF had the lowest percentage of adverse events (P < 0.0001).

CONCLUSION

All three techniques are effective in treating cervical radicular symptoms. MI-PCF has the lowest rate of adverse events whereas CDR has the lowest rate of secondary procedures. There is insufficient evidence to show which technique is the most effective and provides the longest-lasting symptom relief.

LEVEL OF EVIDENCE

摘要

研究设计

已发表的随机对照试验（RCT）的荟萃分析。

研究目的

确定前路颈椎间盘切除融合术（ACDF）、颈椎间盘置换术（CDR）和微创颈椎侧方椎间孔切开术（MI-PCF）治疗单节段、单侧、神经根型颈椎病症状患者的最佳疗效。

背景资料概要

颈椎神经根病的手术治疗仍存在争议。ACDF 已广泛应用为“金标准”。CDR 不断发展并成为一种保留运动的替代方法，其相邻节段疾病的发生率可能较低。然而，这两种技术都需要进行前路颈部解剖，存在严重发病的潜在风险。MI-PCF 是一种保留运动的技术，可以通过微创方式进行，但尚未得到普遍接受。

研究方法

对比较 ACDF、CDR 和 MI-PCF 疗效和有效性的 RCT 进行电子数据库检索。对二次手术和不良事件进行了荟萃分析。

研究结果

共检索到 358 项研究，其中四项 RCT 报告符合本研究的纳入标准。三项研究提供了比较 ACDF 和 CDR 的临床数据，一项研究提供了比较 ACDF 和 MI-PCF 的数据。对分析的 RCT 进行的现有数据得出的结论是，对于对非手术治疗无反应的单节段、单侧神经根型颈椎病患者，ACDF、CDR 和 MI-PCF 均能显著改善相关症状、临床和功能结局。CDR 的二次手术率最低（P=0.0178），而 MICPF 的不良事件发生率最低（P<0.0001）。