Comparison of Complications between Anterior Cervical Diskectomy and Fusion versus Anterior Cervical Corpectomy and Fusion in Two- and Three-Level Cervical Spondylotic Myelopathy: A Meta-analysis

Abstract

Background In this study, we systematically analyze the differences in complications between anterior cervical diskectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) in two- and three-level cervical spondylotic myelopathy (CSM). Methods We performed a systematic search in MEDLINE, EMBASE, PubMed, Web of Science, Cochrane databases, Chinese Biomedical Literature Database, CNKI, and Wan Fang Data for all relevant studies. All statistical analyses were performed using Review Manager version 5.3. Results A total of 11 articles with 849 study subjects were included, with 474 patients in the ACDF group and 375 patients in the ACCF group. The results of the meta-analysis showed that in C5 palsy (odds ratio [OR]: 0.41; 95% confidence interval [CI]: 0.16–1.06), pseudarthrosis (OR: 1.07; 95% CI: 0.23–5.07), dysphagia (OR: 1.06; 95% CI: 0.60–1.86), infection (OR: 0.41; 95% CI: 0.16–1.09), cerebrospinal fluid leakage (OR: 1.21; 95% CI: 0.39–3.73), graft dislodgment (OR: 0.28; 95% CI: 0.06–1.37), and hematoma (OR: 0.32; 95% CI: 0.06–1.83), there are no significant differences between the ACDF and ACCF groups, whereas total complication (OR: 0.50; 95% CI: 0.31–0.80) showed that the ACDF group had a significantly lower morbidity than the ACCF group. Furthermore, the three-level subgroup of ACDF had significantly better results in C5 palsy (OR: 0.31; 95% CI: 0.11–0.88), infection (OR: 0.22; 95% CI: 0.05–0.94), graft dislodgment (OR: 0.07; 95% CI: 0.01–0.40), and total complication (OR: 0.37; 95% CI: 0.23–0.60) compared with the ACCF subgroup. Conclusion In general, postoperative pseudarthrosis, dysphagia, cerebrospinal fluid leakage, hematoma, C5 palsy, infection, and graft dislodgment did not differ significantly between the two groups. Total complication was significantly less in the ACDF group compared to the ACCF group. In the three-level subgroup, the morbidity of C5 palsy, infection, and graft dislodgment was significantly lower in ACDF than in ACCF.

Cervical alignment and clinical outcome of anterior cervical discectomy and fusion vs. anterior cervical corpectomy and fusion in local kyphotic cervical spondylotic myelopathy

“…CSF leak is a serious complication of spinal surgery, and the incidence rate is up to 0.6% for patients who undergo the anterior cervical approaches [ 35 ]. Consistent with previous studies [ 36 , 37 ], our findings also demonstrated that the incidence rates of CSF leak and pseudarthrosis were significantly low in ACDF, compared to ACCF. After repair of the teared dura during surgery, CSF drainage was required within 3 to 5 days after surgery.…”

Vertebral Body Sliding Osteotomy as a Surgical Strategy for the Treatment of Cervical Myelopathy: Outcomes at Minimum Five years Follow-up

“…The fusion rate of the anterior cervical approach is generally considered high, and segments assessed as pseudarthrosis in ACDF and ACCF groups achieved solid fusion during the five-year follow-up, causing no significant differences in results among the three groups. 17,29,30 The degree of subsidence in the first year was also lower in the VBSO group than in the ACCF group, which was similar to previous work. 17 This is because VBSO does not involve the removal of the vertebral body; rather, additional screws are fixed to the translated vertebral body, making it more stable as the lever arm is shorter.…”

“…However, the fusion rate five years postoperatively did not demonstrate significant intergroup differences. The fusion rate of the anterior cervical approach is generally considered high, and segments assessed as pseudarthrosis in ACDF and ACCF groups achieved solid fusion during the five-year follow-up, causing no significant differences in results among the three groups 17,29,30…”

Surgical tactics of two-segmental cervical degenerative diseases: risk factors retrospective assessment and preoperative planning

“…To treat patients with two-segmental symptomatic cervical spondylosis, degenerative disc disease and circumferential cervical spondylotic spinal stenosis ( 6 ), accompanied by some nerve roots and/or the spinal cord compression, methods of two-level anterior cervical discectomy and fusion (ACDF) and one-level anterior cervical corpectomy and fusion (ACCF) are widely used ( 7 ). Specified surgical techniques allow to use the decompression of neural structures effectively, to recover the cervical spine stability and to implement the sagittal balance correction ( 8 ).…”