Sethy Siddharth Sekhar, Goyal Nikhil, Ahuja Kaustubh, Ifthekar Syed, Mittal Samarth, Yadav Gagandeep, Venkata Sudhakar P, Sarkar Bhaskar, Kandwal Pankaj
Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, 249201, India.
Eur Spine J. 2022 Feb;31(2):301-310. doi: 10.1007/s00586-021-07068-9. Epub 2021 Dec 3.
Systematic Review and Meta-analysis.
Three-column injuries making the spine unstable require adequate fixation which can be achieved by anterior alone, posterior alone or combined anterior-posterior approach. There is no general consensus till date on a single best approach in sub-axial cervical spine trauma. This study comparing the three approaches is an attempt to establish a firmer guideline in this disputed topic.
The protocol was registered with PROSPERO. PubMed, Embase and Google Scholar were searched for relevant literature. For each study, pre-defined data were extracted which included correction of kyphosis, loss of correction, hospital stay, operative time, blood loss during surgery as the outcome variables. Studies were also screened for the complications.
Eleven studies were evaluated for qualitative analysis and quantitative synthesis of the data in our review. The result demonstrated significant difference with most correction achieved in combined approach subgroup. Though no significant difference was found, the anterior group was having maximum loss of correction. Combined approach showed significantly more operative time and blood loss followed by posterior approach and then anterior approach alone. The improvement in VAS was significantly more in anterior subgroup when compared to combined approach.
Cervical alignment is best restored by combined approach compared to the other two. Anterior only approach showed more correction than posterior approach. However, there is no significant difference between all three approaches in loss of correction at long-term follow-up. Anterior only approach is superior to posterior and combined approach on basis of intraoperative and perioperative parameters.
Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.
系统评价与荟萃分析。
导致脊柱不稳定的三柱损伤需要充分固定，可通过单纯前路、单纯后路或前后联合入路实现。迄今为止，对于亚轴型颈椎创伤的单一最佳入路尚无普遍共识。本研究比较这三种入路，旨在为这一存在争议的话题建立更可靠的指导原则。
该方案已在国际前瞻性系统评价注册库（PROSPERO）登记。检索了PubMed、Embase和谷歌学术以获取相关文献。对于每项研究，提取预先定义的数据，包括后凸畸形矫正、矫正丢失、住院时间、手术时间、手术期间失血作为结局变量。还对研究中的并发症进行筛查。
在我们的综述中，对11项研究进行了定性分析和数据的定量综合。结果显示联合入路亚组的矫正效果最佳，差异有统计学意义。虽然未发现显著差异，但前路组的矫正丢失最多。联合入路的手术时间和失血量显著多于后路入路，而后路入路又多于单纯前路入路。与联合入路相比，前路亚组的视觉模拟评分（VAS）改善更显著。
与其他两种方法相比，联合入路能最佳地恢复颈椎对线。单纯前路入路的矫正效果优于后路入路。然而在长期随访中，三种入路在矫正丢失方面无显著差异。基于术中及围手术期参数，单纯前路入路优于后路及联合入路。
证据等级I：诊断性：采用一致应用的参考标准且实施盲法的个体横断面研究
