Open AccessEfficacy and Safety of Surgical Interventions for Treating Multilevel Cervical Spondylotic Myelopathy via Anterior Approach: A Network Meta-Analysis
Author(s) -
Bo Li
Publication year - 2019
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj/2019.22.e275
Subject(s) - medicine , corpectomy , meta analysis , confidence interval , odds ratio , anterior cervical discectomy and fusion , randomized controlled trial , cervical spondylosis , surgery , cervical spine , alternative medicine , pathology
Background: Anterior cervical discectomy, with or without interbody fusion, is a commontechnique to treat cervical spondylotic myelopathy (CSM). To date, controversy still existsamong spine surgeons regarding the anterior surgical approach to be used for the treatmentof multilevel CSM.Objectives: To evaluate the effectiveness and safety of anterior cervical discectomy andfusion (ACDF), anterior cervical corpectomy and fusion (ACCF), cervical total disc replacement(CTDR), and hybrid surgery (HS) in the treatment of multilevel CSM.Study Design: Network meta-analysis (NMA) of randomized or nonrandomized controlledstudies for the treatment of multilevel CSM.Methods: The databases such as PubMed, CENTRAL, and EMBASE were used to search andidentify the clinical trials involving the evaluations for the treatment of multilevel CSM. TheNewcastle-Ottawa Scale was used for the assessment of methodological qualities, whereasthe Cochrane Collaboration tool was used for assessing the risk of bias. Outcome assessmentsincluded duration of surgery, Neck Disability Index (NDI) scores, and complications. Oddsratio was used to express dichotomous outcomes, whereas mean difference with a 95%confidence interval was used to express continuous outcomes.Results: Sixteen relevant studies were identified, and 1,639 patients were included in thisanalysis. CTDR demonstrated a prominently decreased NDI score and total incidence ofcomplications compared with ACDF, ACCF, and HS. In addition, ACDF resulted in shorteroperation times compared with ACCF, CTDR, and HS. The ranked order of NDI scoreimprovement in decreasing order was: CTDR, HS, ACDF, followed by ACCF. The rank orderfor reduction in operation time increased progressively from ACDF, HS, ACCF to CTDR. Thetotal incidence of complications also showed a decreasing trend in the decreasing order—CTDR, ACDF, HS, ACCF, and finally CTDR with the lowest complication rate.Limitations: The limitations of this NMA include inconformity of the follow-up times andsurgical skill, and implants of different treatment centers vary.Conclusions: The analysis of this study has shown that the best method for improvementof functional outcome and reduction in total incidence of complications for multilevel CSMis CTDR.Key words: Multilevel cervical spondylotic myelopathy, anterior cervical discectomy andfusion, anterior cervical corpectomy and fusion, cervical total disc replacement, hybrid surgery,effectiveness, safety, network meta-analysis