Department of Spine Surgery, Lishui People's Hospital, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, China.
Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China.
Neurosurg Rev. 2024 Oct 11;47(1):783. doi: 10.1007/s10143-024-02977-x.
This study aimed to systematically review and compare the efficacy and safety of anterior cervical controllable antedisplacement and fusion (ACAF) versus anterior cervical corpectomy and fusion (ACCF) in treating ossification of the cervical posterior longitudinal ligament (OPLL), focusing on surgery-related indicators and postoperative outcomes. This review was conducted and reported in accordance with the Cochrane Handbook for Systematic Reviews of Interventions guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting standards. The methodological quality of this systematic review was assessed using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) checklist. A detailed search strategy was implemented to retrieve literature from electronic databases, including PubMed, EMBASE, and the Cochrane Library, followed by quality assessment and data extraction for eligible studies. A total of 5 studies involving 366 participants were included. ACAF was associated with significantly fewer complications (OR = 0.25, 95% CI [0.12, 0.51], p = 0.000), including a lower incidence of cerebrospinal fluid (CSF) leakage (OR = 0.20, 95% CI [0.08, 0.52], p = 0.000). ACAF also showed better outcomes in postoperative neck disability index (NDI) scores (SMD = -0.48, 95% CI [-0.81, -0.15], p = 0.020), C2-C7 angle (SMD = 1.29, 95% CI [0.56, 2.03], p = 0.000), spinal canal area (SCA) (SMD = 0.93, 95% CI [0.56, 1.29], p = 0.000), and diameter of the spinal cord (DSC) (SMD = 0.38, 95% CI [0.11, 0.66], p = 0.010). Additionally, ACAF improved The Japanese Orthopedic Association (JOA) scores (SMD = 0.29, 95% CI [0.01, 0.57], p = 0.040) but required longer operation time (SMD = 1.08, 95% CI [0.01, 2.15], p = 0.049). No significant differences were found in blood loss (SMD = 0.23, 95% CI [-0.34, 0.79], p = 0.431), hospital stay (SMD = 0.65, 95% CI [-1.46, 2.76], p = 0.547), and improvement rate (IR) (SMD = 0.38, 95% CI [-0.10, 0.86], p = 0.118). The current meta-analysis indicated that ACAF surgery can effectively reduce the incidence of complications, significantly increase the spinal canal area and improve the spatial conditions of the spinal cord compared to those associated with ACCF surgery. This is more advantageous for the postoperative neurological recovery of patients. Nonetheless, it is crucial to approach these findings with a degree of caution.
本研究旨在系统地回顾和比较前颈椎可控前移位融合术（ACAF）与前颈椎椎体切除术和融合术（ACCF）治疗颈椎后纵韧带骨化症（OPLL）的疗效和安全性，重点关注手术相关指标和术后结果。本综述是根据 Cochrane 干预系统评价手册和系统评价和荟萃分析的 Preferred Reporting Items（PRISMA）报告标准进行的。使用 Assessing the Methodological Quality of Systematic Reviews（AMSTAR）清单评估了本系统评价的方法学质量。通过实施详细的检索策略，从电子数据库（包括 PubMed、EMBASE 和 Cochrane Library）中检索文献，对合格研究进行质量评估和数据提取。共纳入 5 项涉及 366 名参与者的研究。ACAF 与明显更少的并发症相关（OR = 0.25，95%CI [0.12，0.51]，p = 0.000），包括脑脊液（CSF）漏的发生率更低（OR = 0.20，95%CI [0.08，0.52]，p = 0.000）。ACAF 还在术后颈部残疾指数（NDI）评分（SMD = -0.48，95%CI [-0.81，-0.15]，p = 0.020）、C2-C7 角（SMD = 1.29，95%CI [0.56，2.03]，p = 0.000）、椎管面积（SCA）（SMD = 0.93，95%CI [0.56，1.29]，p = 0.000）和脊髓直径（DSC）（SMD = 0.38，95%CI [0.11，0.66]，p = 0.010）方面表现出更好的结果。此外，ACAF 提高了日本矫形协会（JOA）评分（SMD = 0.29，95%CI [0.01，0.57]，p = 0.040），但手术时间更长（SMD = 1.08，95%CI [0.01，2.15]，p = 0.049）。在出血量（SMD = 0.23，95%CI [-0.34，0.79]，p = 0.431）、住院时间（SMD = 0.65，95%CI [-1.46，2.76]，p = 0.547）和改善率（IR）（SMD = 0.38，95%CI [-0.10，0.86]，p = 0.118）方面无显著差异。目前的荟萃分析表明，与 ACCF 手术相比，ACAF 手术可有效降低并发症发生率，显著增加椎管面积，改善脊髓空间条件，更有利于患者术后神经功能恢复。然而，对这些发现的解读需要保持一定的谨慎。
