A Comparison of Multilevel Anterior Cervical Discectomy and Corpectomy in Patients With 4-level Cervical Spondylotic Myelopathy: a Minimum 2-year Follow-up Study

Huang, Jianguo; Zhang, Zhizhong; Li, Fengning; Hou, Tiesheng; Hou, Shuxun

doi:10.1097/bsd.0000000000000212

Cited by 42 publications

(38 citation statements)

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“…Three studies (368 of 878 patients) [50,51,55] reported preoperative and the final follow-up NDI scores between ACDF and ACCF. The meta-analysis showed that there is no significant difference between ACDF and ACCF in preoperative and the final follow-up NDI scores ( P = 0.38, SMD = 0.28 [−0.35, 0.91]; heterogeneity: P = 0.59, I 2 = 0%, fixed-effects model, Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Five studies (350 of 878 patients) [50,52,54–55,57] reported fusion rate between ACDF and ACCF. The meta-analysis showed that ACDF have a better result of fusion rate than that of ACCF ( P = 0.04, OR 2.54, 95% CI 1.05, 6.11; heterogeneity: P = 0.29, I 2 = 20%, fixed-effects model, Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Four studies (365 of 878 patients) [50,53–55] reported incidence of graft subsidence between ACDF and ACCF. The meta-analysis showed that ACDF is less than ACCF in incidence of graft subsidence ( P = 0.004, OR 0.11, 95% CI 0.02, 0.48; heterogeneity: P = 0.94, I 2 = 0%, fixed-effects model, Fig.…”

Section: Resultsmentioning

confidence: 99%

“…[23,52–55] The common operative options included anterior, posterior, and combined anteroposterior approaches. In the 1960s, posterior approaches including laminectomy and laminoplasty were widely used in the treatment of mCSM.…”

Section: Discussionmentioning

confidence: 99%

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Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion in multilevel cervical spondylotic myelopathy

Wang

Liu

et al. 2016

Medicine

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Background:Both anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are used to treat multilevel cervical spondylotic myelopathy (mCSM); however, which one is better treatment for mCSM remains considerable controversy. A meta-analysis was performed to compare clinical outcomes, radiographic outcomes, and surgical outcomes between ACDF and ACCF in treatment for mCSM.Methods:An extensive search of literature was performed in Pubmed/MEDLINE, Embase, the Cochrane library, CNKI, and WANFANG databases on ACDF versus ACCF treatment for mCSM from January 2011 to August 2016. The following variables were extracted: length of hospital stay, blood loss, operation time, Japanese Orthopedic Association (JOA) scores, Neck Disability Index (NDI) score, fusion rate, Cobb angles of C2 to C7, dysphagia, hoarseness, C5 palsy, infection, cerebral fluid leakage, donor site pain, epidural hematoma, graft subsidence, graft dislodgment, pseudoarthrosis, and total complications. Data analysis was conducted with RevMan 5.3 and STATA 12.0.Results:A total of 8 studies containing 878 patients were included in our study. The results showed that ACDF is better than ACCF in the angle of C2 to C7 at the final follow-up (P < 0.00001, standardized mean difference = 4.76 [3.48, 6.03]; heterogeneity: P = 0.17, I2 = 43%), C5 plasy (P = 0.02, odds ratio [OR] 0.42, 95% confidence interval [CI] 0.21, 0.86; heterogeneity: P = 0.52, I2 = 0%), blood loss (P < 0.00001, standardized mean difference = −53.12, 95% CI −64.61, −41.64; heterogeneity: P = 0.29, I2 = 20%), fusion rate (P = 0.04, OR 2.54, 95% CI 1.05, 6.11; heterogeneity: P = 0.29, I2 = 20%), graft subsidence (P = 0.004, OR 0.11, 95% CI 0.02, 0.48; heterogeneity: P = 0.94, I2 = 0%), and total complications (P = 0.0009, OR 0.56, 95% CI 0.40, 0.79; heterogeneity: P = 0.29, I2 = 18%).However, there are no significant differences in length of hospital stay, operation time, JOA scores, NDI scores, preoperative angle of C2 to C7, dysphagia, hoarseness, infection, cerebral fluid leakage, donor site pain, epidural hematoma, graft dislodgment, and pseudoarthrosis (all P > 0.05).Conclusions:Based on our meta-analysis, our results suggest that both ACDF and ACCF are good plans in clinical outcomes; however, ACDF is a better choice in radiographic outcomes and total complications for the treatment of multilevel CSM.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion in multilevel cervical spondylotic myelopathy

Wang

Liu

et al. 2016

Medicine

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“…For these reasons, its superiority has not been established. Only a small number of retrospective analyses have been done [45][46][47][48][49][50], and no randomized trials have been reported. Several meta-analyses indicated that ACDF is associated with less surgical complications and better post-operative alignment [51][52][53][54][55].…”

Section: Anterior Fusion By Discectomy Versus Corpectomymentioning

confidence: 99%

Degenerative cervical myelopathy

Kato

Fehlings

2016

Curr Rev Musculoskelet Med

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Cervical myelopathy is the most common cause of acquired spinal cord compromise. The concept of degenerative cervical myelopathy (DCM), defined as symptomatic myelopathy associated with degenerative arthropathic changes in the spine axis, is being introduced. Given its progressive nature, treatment options have to be chosen in a timely manner. Surgical options include anterior discectomy and fusion (ACDF), anterior corpectomy and fusion (ACCF), arthroplasty (in highly select cases), posterior laminectomy with/without fusion, and laminoplasty. Indications for each should be carefully considered in individual patients. Riluzole, a sodium-glutamate antagonist, is a promising option to optimize neurologic outcomes post-surgery and is being examined in the CSM-Protect Randomized Controlled Trial. Preoperative risk assessment is mandatory for prognostication. Sagittal alignment is known to play an important role to optimize surgical outcome. Guidelines for optimal management of DCM are in process. In principle, all but the mildest cases of DCM should be offered surgery for optimal outcome.

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Cervical Corpectomy

Callanan¹,

Rahman²,

Radcliff³

2019

The Resident's Guide to Spine Surgery

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A Comparison of Multilevel Anterior Cervical Discectomy and Corpectomy in Patients With 4-level Cervical Spondylotic Myelopathy: a Minimum 2-year Follow-up Study

Abstract: Both mACDF and sACCF provide satisfactory clinical outcomes and fusion rates for 4-level CSM. However, mACDF is associated with better radiologic parameter, less blood loss, and lower instrumentation-related and/or graft-related complication rate.

Cited by 42 publications

References 50 publications

Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion in multilevel cervical spondylotic myelopathy

Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion in multilevel cervical spondylotic myelopathy

Degenerative cervical myelopathy

Cervical Corpectomy

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