Das Anand Kumar, Purohit Devendra Kumar, Gupta Ajay, Kataria Rashim
Department of Neurosurgery, All India Institute of Medical Sciences, Patna, India.
Department of Neurosurgery, SMS Medical College and Hospital, Jaipur, India.
Asian Spine J. 2023 Jun;17(3):567-581. doi: 10.31616/asj.2022.0179. Epub 2023 May 22.
Anterior cervical corpectomy and fusion is considered the mainstay of surgical treatment in cervical pathology. Expandable and nonexpandable cages are preferred over autogenous bone graft because of donor-related morbidity. However, the choice of the cage type remains a debatable topic as studies report conflicting results. Thus, we evaluated the outcomes of expandable and non-expandable cages following cervical corpectomy. Studies were searched in various electronic databases (MEDLINE, PubMed, EMBASE, CINAHL, Scopus, and Cochrane) between 2011 and 2021. Forest plot was made to compare the radiological and clinical outcomes between expandable and non-expandable cages following cervical corpectomy. Altogether, 26 studies (1,170 patients) were included in the metaanalysis. The mean change in segmental angle was significantly greater in the expandable cage group than in the non-expandable cage group (6.7° vs. 3.0°, p <0.001). The mean subsidence rate was lower in the expandable cage group (6% vs. 41%, p <0.001). The mean fusion rate was lower (93% vs. 98%, p =0.06) and the mean displacement rate was significantly higher in the expandable cage group (29% vs. 5%, p <0.05). The mean reoperation rate was higher in the expandable cage group (16% vs. 2%, p >0.05). The improvement in segmental angle is better with expandable cages. Higher subsidence is a major problem with non-expandable cages, but it seems to be beneficial as evidenced by the high fusion rate and minimal effect on clinical outcome in patients with this cage.
颈椎椎体次全切除融合术被认为是颈椎疾病外科治疗的主要方法。由于供体相关的并发症，可扩张和不可扩张椎间融合器比自体骨移植更受青睐。然而，椎间融合器类型的选择仍然是一个有争议的话题，因为研究报告的结果相互矛盾。因此，我们评估了颈椎椎体次全切除术后可扩张和不可扩张椎间融合器的疗效。在2011年至2021年期间，在各种电子数据库（MEDLINE、PubMed、EMBASE、CINAHL、Scopus和Cochrane）中进行了检索。绘制森林图以比较颈椎椎体次全切除术后可扩张和不可扩张椎间融合器的放射学和临床疗效。总共26项研究（1170例患者）纳入了荟萃分析。可扩张椎间融合器组的节段角度平均变化显著大于不可扩张椎间融合器组（6.7°对3.0°，p<0.001）。可扩张椎间融合器组的平均沉降率较低（6%对41%，p<0.001）。可扩张椎间融合器组的平均融合率较低（93%对98%，p =0.06），平均移位率显著较高（29%对5%，p<0.05）。可扩张椎间融合器组的平均再次手术率较高（16%对2%，p>0.05）。可扩张椎间融合器的节段角度改善更好。较高的沉降是不可扩张椎间融合器的一个主要问题，但从高融合率和对使用该椎间融合器的患者临床结果影响最小来看，似乎是有益的。
