Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN.
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN.
Spine (Phila Pa 1976). 2018 Apr 1;43(7):E413-E422. doi: 10.1097/BRS.0000000000002441.
Systematic review and meta-analysis.
To compare postoperative surgical, radiographic, and patient-reported outcomes following anterior cervical discectomy and fusion (ACDF) with and without plate fixation.
ACDF has evolved significantly over the years, including the placement of an anterior plate construct. Although promoting bony osseo-integration at the fusion site, there are a number of plate-related complications that can arise. The non-plating approach is less invasive, however, greater rates of cage subsidence have been associated with this model.
We performed an electronic literature search for human studies that directly compared ACDF with and without anterior plate fixation. Outcomes of interest comprised of postoperative dysphagia, fusion success, and cage subsidence as well as patient reported outcomes, including the Neck Disability Index (NDI) scores and Visual Analog Scale (VAS) for both neck and arm pain.
A total of 15 studies (12 observational and 3 randomized controlled trials) and 893 patients (57% males) were included. Overall, ACDF with plate fixation was associated with significantly higher vertebral fusion rates (odds ratio [OR] 1.98; 95% confidence interval [CI] 1.16-3.37), lower subsidence rates (odds ratio [OR] 0.31, 95% CI 0.18-0.52), and more favorable VAS-neck pain scores at last follow-up (mean difference [MD] 0.59, 95% CI -0.78 to -0.41). Conversely, ACDF procedures without plate fixation had marginally better long-term VAS-arm pain scores (mean difference [MD] 0.2, 95% CI 0.04-0.36). No difference was found with regards to dysphagia (OR 1.21, 95% CI, 0.57-2.56) and NDI (MD 0.06, 95% C.I -0.54 to 0.42).
Available evidence, although limited, suggests superior surgical outcomes in ACDF procedures with anterior plate fixation (increased fusion, decreased subsidence) and slightly better VAS-neck pain scores at last follow-up. Future longitudinal, multicenter randomized controlled trials should be completed to validate any associations found in this study.
系统评价和荟萃分析。
比较颈椎前路椎间盘切除融合术（ACDF）联合和不联合钢板固定的术后手术、影像学和患者报告的结果。
ACDF 多年来有了显著的发展，包括在前部放置钢板结构。尽管促进融合部位的骨性骨整合，但可能会出现许多与钢板相关的并发症。非钢板方法侵袭性较小，然而，与该模型相关的笼状沉降发生率更高。
我们对直接比较 ACDF 联合和不联合前路钢板固定的人类研究进行了电子文献检索。感兴趣的结果包括术后吞咽困难、融合成功率和笼状沉降以及患者报告的结果，包括颈部残疾指数（NDI）评分和颈部和手臂疼痛的视觉模拟量表（VAS）。
共纳入 15 项研究（12 项观察性研究和 3 项随机对照试验）和 893 名患者（57%为男性）。总体而言，ACDF 联合钢板固定与更高的椎体融合率显著相关（优势比 [OR] 1.98；95%置信区间 [CI] 1.16-3.37）、更低的沉降率（OR 0.31，95%CI 0.18-0.52）和更有利的末次随访 VAS-颈部疼痛评分（平均差异 [MD] 0.59，95%CI -0.78 至 -0.41）。相反，无钢板固定的 ACDF 手术具有稍好的长期 VAS-手臂疼痛评分（平均差异 [MD] 0.2，95%CI 0.04-0.36）。在吞咽困难（OR 1.21，95%CI，0.57-2.56）和 NDI（MD 0.06，95%CI -0.54 至 0.42）方面无差异。
尽管证据有限，但现有证据表明颈椎前路椎间盘切除融合术联合前路钢板固定具有更好的手术效果（增加融合、减少沉降），并且在末次随访时 VAS-颈部疼痛评分稍高。未来应完成纵向、多中心随机对照试验，以验证本研究中发现的任何关联。
3 级。
