Wang Tao, Guo Junfei, Long Yubin, Hou Zhiyong
Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, R. China.
Anterior cervical discectomy and fusion and anterior cervical corpectomy and fusion, Orthopaedic Research Institute of Hebei Province, Shijiazhuang, People's Republic of China.
Geriatr Orthop Surg Rehabil. 2022 Aug 28;13:21514593221124415. doi: 10.1177/21514593221124415. eCollection 2022.
A meta-analysis.
Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are widely used in the treatment of cervical spondylotic myelopathy (CSM). However, the clinical outcomes and complications between ACDF and ACCF treating multi-level CSM remain poorly understood. Thus, we performed a meta-analysis to compare the clinical outcomes and complications of the two procedures in the treatment of 3-level and 4-level CSM.
An extensive search of the literature was performed in the English databases of PubMed, Embase, and Cochrane Library and the Chinese databases of CNKI and WANFANG. We collected factors, including demographic data, surgical factors, and complications. Data analysis was conducted with RevMan 5.3 and STATA 12.0.
Finally, 14 articles (5429 patients) were included in our study. No significant difference was found in preoperative and 3-month follow-up Japanese Orthopedic Association (JOA) scores, neck disability index, preoperative C2-C7, segmental angle, operation time, as well as the number of dysphagia, hoarseness, cerebral fluid leakage, infection, epidural hematoma, axial pain, hardware breakage, and pseudarthrosis between ACDF and ACCF. However, our findings showed that blood loss ( < 0.00001), the number of total complications ( < 0 .00001), C5 palsy ( = 0.0004), graft dislodgement ( = 0.02), graft subsidence ( = 0.0003), and revision surgery ( = 0.0008) in ACDF were significantly less than in ACCF. Additionally, postoperative and change of C2-C7 ( < 0.00001), segment angle ( < 0.00001), and fusion rate ( = 0.001) in ACDF were significantly higher than in ACCF. Post-operative JOA in ACDF was significantly higher than in ACCF ( = 0.02).
Although the clinical efficacy of both surgeries was similar, ACDF was superior to ACCF in the reconstruction of cervical lordosis and the number of complications in the treatment of 3-level and 4-level CSM.
一项荟萃分析。
颈椎前路椎间盘切除融合术（ACDF）和颈椎前路椎体次全切除融合术（ACCF）广泛应用于治疗脊髓型颈椎病（CSM）。然而，ACDF和ACCF治疗多节段CSM的临床疗效和并发症仍知之甚少。因此，我们进行了一项荟萃分析，以比较这两种手术治疗3节段和4节段CSM的临床疗效和并发症。
在英文数据库PubMed、Embase和Cochrane图书馆以及中文数据库CNKI和万方中广泛检索文献。我们收集了包括人口统计学数据、手术因素和并发症等因素。使用RevMan 5.3和STATA 12.0进行数据分析。
最终，我们的研究纳入了14篇文章（5429例患者）。ACDF和ACCF在术前和术后3个月的日本骨科协会（JOA）评分、颈部功能障碍指数、术前C2-C7、节段角度、手术时间以及吞咽困难、声音嘶哑、脑脊液漏、感染、硬膜外血肿、轴性疼痛、内固定断裂和假关节形成的数量方面均未发现显著差异。然而，我们的研究结果表明，ACDF的失血量（<0.00001）、总并发症数量（<0.00001）、C5麻痹（=0.0004）、植骨移位（=0.02）、植骨下沉（=0.0003）和翻修手术（=0.0008）均显著少于ACCF。此外，ACDF术后C2-C7的变化（<0.00001）、节段角度（<0.00001）和融合率（=0.001）均显著高于ACCF。ACDF术后的JOA评分显著高于ACCF（=0.02）。
虽然两种手术的临床疗效相似，但在治疗3节段和4节段CSM时，ACDF在颈椎生理前凸重建和并发症数量方面优于ACCF。
