Anterior versus posterior approach for the therapy of multilevel cervical spondylotic myelopathy: a meta-analysis and systematic review

Zhang, Long; Chen, Jia; Cao, Can; Zhang, Yazhou; Shi, Lei; Zhai, Jinshuai; Huang, Tzung Chi; Li, Xicheng

doi:10.1007/s00402-018-03102-6

Cited by 22 publications

(19 citation statements)

References 28 publications

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“…Cervical corpectomy is a well-established technique to treat cervical stenosis. 15 , 16 Surgeons use a wide range of implants to reconstruct the spine including bone, fixed and expandable titanium, and polyether ether ketone (PEEK) cages. 17 Autografts have a high fusion rate, but there are risks of graft migration and donor site complications.…”

Section: Discussionmentioning

confidence: 99%

Poor Fusion Rates Following Cervical Corpectomy Reconstructed With an Expandable Cage: Minimum 2-Year Radiographic and Clinical Outcomes

et al. 2021

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BACKGROUND Expandable cages are often used to reconstruct cervical corpectomies but there are few long-term follow-up studies with large numbers. OBJECTIVE To analyze the clinical and radiographic results of cervical corpectomy reconstructed with expandable cages for degenerative stenosis. METHODS We performed a retrospective analysis of 78 patients with degenerative cervical stenosis treated with a corpectomy reconstructed with an expandable cage. We evaluated the clinical and radiographic outcomes, as well as complications of the procedure at a minimum 2-yr follow-up. RESULTS There was a decrease in the visual analog scale pain average from 75 mm to 8.5 mm (P = .02); a decrease in the Neck Disability Index average from 55% to 12% (P = .009); and improvement in the Japanese Orthopaedic Association average from 12 to 14 points (P = .01). There was a change in cervical lordosis (Cobb method) average from −9.3° to −15.1° (P = .002), without significant loss of lordosis (P = .63). The fusion rate, by criteria of the Cervical Spine Research Society (CSRS), was low: using dynamic X-rays – 50% (n = 39/78) and using computed tomography (CT) – 47.4% (n = 37/78). A total of 11 patients (14.1%) suffered complications. CONCLUSION To our knowledge, this is the largest series (78) with a minimum 2-yr follow-up in the literature and the first using the dynamic radiographic and CT criteria endorsed by the CSRS. Using these criteria, our fusion rates were much lower than all previous reports in the literature. Despite this, patient-reported outcomes were reasonable. There was a relatively low incidence of perioperative complications, most of which were likely not implant-specific and there was only 1 case of implant failure.

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Section: Discussionmentioning

confidence: 99%

Poor Fusion Rates Following Cervical Corpectomy Reconstructed With an Expandable Cage: Minimum 2-Year Radiographic and Clinical Outcomes

et al. 2021

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“…Nouri et al conducted a questionnaire survey among 513 AOSpine International members to understand how specific pathologic features on MRI influence the surgeon’s selection of a surgical approach selection in patients with degenerative CM [37]. Multilevel bulging disks, cervical kyphosis, and a high degree of anterior cord compression have been reported to lead to selection of an anterior approach, whereas a high degree of posterior cord compression, multilevel compression, OPLL, ligamentum flavum enlargement, and congenital stenosis have been reported to lead to selection of a posterior approach [2, 3, 37]. Although the presence of ISI on T2-weighted MRI is not considered an important factor that influences decision-making, interviewers were slightly more likely to choose the anterior approach than the posterior approach (23.4% vs. 15.6%, respectively).…”

Section: Discussionmentioning

confidence: 99%

Surgical approaches and outcomes for cervical myelopathy with increased signal intensity on T2-weighted MRI: a meta-analysis

Chen

Wang

et al. 2019

J Orthop Surg Res

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Objective Increased signal intensity (ISI) on T2-weighted magnetic resonance imaging (MRI) often indicates severe compression in patients with cervical myelopathy (CM). The optimal surgical approach for CM patients with ISI on T2-weighted MRI remains unclear. This meta-analysis aims to compare the clinical outcomes between anterior and posterior approaches for the treatment of these patients. Methods MEDLINE, EMBASE, Web of Science, and Chinese National Knowledge Infrastructure (CNKI) were searched for relevant studies through January 2019. Statistical comparisons were made when appropriate. Results A total of 9 studies (748 participants) out of 1066 citations were included in this study. All of the selected studies were high quality, as indicated by the Newcastle–Ottawa scale and the Cochrane Collaboration tool for assessing the risk of bias. Clinical outcomes were compared between anterior and posterior approaches in 4 studies (237 participants). The preoperative Japanese Orthopedic Association (JOA) score was similar between the two groups [ P = 0.98, weighted mean difference (WMD) = 0.01 (− 0.58, 0.59)]. The postoperative JOA score [ P < 0.05, WMD = 0.68 (0.06, 1.30)] and recovery rates [ P < 0.01, WMD = 0.12 (0.06, 0.17)] were significantly higher in the anterior group than in the posterior group. Conclusion The anterior approach was associated with better postoperative neural function than the posterior approach in CM patients with ISI on T2-weighted MRI.

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“…ЛФ способствует значительной декомпрессии спинного мозга и восстановлению сегментарной стабильности [8]. Но при этом существуют значительные риски миграции погружных конструкций, сохранения болевого синдрома за счет диссекции паравертебральных мышц и ускоренной дегенерации смежных сегментов [3].…”

Section: да даunclassified

“…Основными методиками оперативных вмешательств являются вентральная декомпрессия с установкой кейджей или телескопических протезов и дорсальные декомпрессивно-стабилизирующие методики в виде ламинотомии с ламинопластикой (ЛП) и ламинэктомии с винтовой фиксацией (ЛФ) [3,7]. Установлено, что передние хирургические способы эффективны при односегментарной дегенерации и имеют высокую частоту формирования костного блока [8]. При этом дорсальные методы считаются оптимальными при многоуровневой патологии [9].…”

Section: Introductionunclassified

Development of differentiated surgical technique for treating patients with multilevel degenerative diseases of cervical spine

Byvaltsev

Калинин

Aliev

et al. 2019

Innovacionnaâ medicina Kubani

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Background. Currently, there is no uniform tactics for the differentiated use of dorsal decompressive-stabilizing techniques for multilevel degenerative diseases of the cervical spine, and the results of these technologies application are largely controversial.Aim. Analysis of the unsatisfactory outcomes of dorsal decompressive-stabilizing interventions in the treatment of patients with multilevel degenerative diseases of the cervical spine and development of a clinicalinstrumental algorithm for differentiated surgical tactics.Material and methods. A retrospective study included 112 patients with degenerative diseases of the cervical spine at two levels or more due to hernias of intervertebral discs, yellow ligament hypertrophy and arthrosis of facet joints, which in 2007-2014 underwent dorsal decompressive-stabilizing interventions in the volume of laminotomy with laminoplasty (LP) and laminectomy with fixation for lateral masses (LF). A correlation analysis of clinical parameters with anamnestic data, instrumental parameters, a feature of accepted surgical tactics and postoperative adverse effects.Results. In the analysis, it was established that «satisfactory» postoperative outcomes of LP are associated with a neutral or lordotic configuration of the cervical spine, the preservation of segmental movements without clinical and instrumental signs of instability; In addition, the use of LF is possible with mobile kyphotization of the cervical spine and the presence of translational instability of the cervical segments. The «unsatisfactory» postoperative results of the LP and LF are in direct correlation with the duration of the disease, the presence of myelopathic focus and rigid kyphosis of the cervical region.Conclusion. Differential use of dorsal decompressive-stabilizing techniques based on a comprehensive assessment of disease duration, configuration of the cervical spine, spinal cord condition and volume of segmental movements allows to reduce neurological symptoms, improve the level of pain and improve the functional status of patients, as well as significantly reduce the number of adverse outcomes associated with the progression of kyphotic deformity, deterioration of neurological symptoms and revision on-line decompressive-stabilizing interventions.

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Anterior versus posterior approach for the therapy of multilevel cervical spondylotic myelopathy: a meta-analysis and systematic review

Cited by 22 publications

References 28 publications

Poor Fusion Rates Following Cervical Corpectomy Reconstructed With an Expandable Cage: Minimum 2-Year Radiographic and Clinical Outcomes

Poor Fusion Rates Following Cervical Corpectomy Reconstructed With an Expandable Cage: Minimum 2-Year Radiographic and Clinical Outcomes

Surgical approaches and outcomes for cervical myelopathy with increased signal intensity on T2-weighted MRI: a meta-analysis

Development of differentiated surgical technique for treating patients with multilevel degenerative diseases of cervical spine

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