Department of Orthopedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China.
Department of Orthopedics, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China.
Pain Physician. 2019 Jul;22(4):E275-E286.
Anterior cervical discectomy, with or without interbody fusion, is a common technique to treat cervical spondylotic myelopathy (CSM). To date, controversy still exists among spine surgeons regarding the anterior surgical approach to be used for the treatment of multilevel CSM.
To evaluate the effectiveness and safety of anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), cervical total disc replacement (CTDR), and hybrid surgery (HS) in the treatment of multilevel CSM.
Network meta-analysis (NMA) of randomized or nonrandomized controlled studies for the treatment of multilevel CSM.
The databases such as PubMed, CENTRAL, and EMBASE were used to search and identify the clinical trials involving the evaluations for the treatment of multilevel CSM. The Newcastle-Ottawa Scale was used for the assessment of methodological qualities, whereas the Cochrane Collaboration tool was used for assessing the risk of bias. Outcome assessments included duration of surgery, Neck Disability Index (NDI) scores, and complications. Odds ratio was used to express dichotomous outcomes, whereas mean difference with a 95% confidence interval was used to express continuous outcomes.
Sixteen relevant studies were identified, and 1,639 patients were included in this analysis. CTDR demonstrated a prominently decreased NDI score and total incidence of complications compared with ACDF, ACCF, and HS. In addition, ACDF resulted in shorter operation times compared with ACCF, CTDR, and HS. The ranked order of NDI score improvement in decreasing order was: CTDR, HS, ACDF, followed by ACCF. The rank order for reduction in operation time increased progressively from ACDF, HS, ACCF to CTDR. The total incidence of complications also showed a decreasing trend in the decreasing order-CTDR, ACDF, HS, ACCF, and finally CTDR with the lowest complication rate.
The limitations of this NMA include inconformity of the follow-up times and surgical skill, and implants of different treatment centers vary.
The analysis of this study has shown that the best method for improvement of functional outcome and reduction in total incidence of complications for multilevel CSM is CTDR.
Multilevel cervical spondylotic myelopathy, anterior cervical discectomy and fusion, anterior cervical corpectomy and fusion, cervical total disc replacement, hybrid surgery, effectiveness, safety, network meta-analysis.
颈椎前路椎间盘切除融合术（ACDF）联合或不联合椎体间融合术是治疗颈椎病脊髓病（CSM）的常用技术。迄今为止，脊柱外科医生在治疗多节段 CSM 时使用的前路手术方法仍存在争议。
评估颈椎前路椎间盘切除融合术（ACDF）、颈椎前路椎体次全切除融合术（ACCF）、颈椎前路椎间盘置换术（CTDR）和杂交手术（HS）治疗多节段 CSM 的有效性和安全性。
治疗多节段 CSM 的随机或非随机对照研究的网络荟萃分析（NMA）。
使用 PubMed、CENTRAL 和 EMBASE 等数据库搜索并确定了评估治疗多节段 CSM 的临床试验。采用纽卡斯尔-渥太华量表评估方法学质量，采用 Cochrane 协作工具评估偏倚风险。结局评估包括手术时间、颈残障指数（NDI）评分和并发症。二分类结局采用优势比表示，连续性结局采用均数差及 95%置信区间表示。
共纳入 16 项相关研究，共 1639 例患者。与 ACDF、ACCF 和 HS 相比，CTDR 显著降低了 NDI 评分和并发症总发生率。此外，与 ACCF、CTDR 和 HS 相比，ACDF 手术时间更短。按 NDI 评分改善程度降序排列，结果依次为：CTDR、HS、ACDF，其次是 ACCF。手术时间缩短的排序顺序从 ACDF、HS、ACCF 逐渐增加到 CTDR。并发症总发生率也呈递减趋势-CTDR、ACDF、HS、ACCF，最后是 CTDR，其并发症发生率最低。
本 NMA 的局限性包括不同治疗中心的随访时间和手术技能的不一致性，以及植入物的不同。
本研究的分析表明，改善多节段 CSM 功能结局和降低总并发症发生率的最佳方法是 CTDR。
多节段颈椎病脊髓病；颈椎前路椎间盘切除融合术；颈椎前路椎体次全切除融合术；颈椎前路椎间盘置换术；杂交手术；有效性；安全性；网络荟萃分析。
