Comparison of two anterior fusion methods in two-level cervical spondylosis myelopathy: a meta-analysis

Abstract

ObjectiveThe aim of this study was to evaluate the efficacy and safety of anterior cervical corpectomy and fusion (ACCF) and anterior cervical discectomy and fusion (ACDF) for treating two-adjacent-level cervical spondylosis myelopathy (CSM).DesignA meta-analysis of the two anterior fusion methods was conducted. The electronic databases of PubMed, the Cochrane Central Register of Controlled Trials, ScienceDirect, CNKI, WANFANG DATA and CQVIP were searched. Quality assessment of the included studies was evaluated using the Cochrane Risk of Bias Tool and the Methodological Index for Non-Randomised Studies criteria. Pooled risk ratios of dichotomous outcomes and standardised mean differences (SMDs) of continuous outcomes were generated. Using the χ2 and I2 tests, the statistical heterogeneity was assessed. Subgroup and sensitivity analyses were also performed.ParticipantsNine eligible trials with a total of 631 patients and a male-to-female ratio of 1.38:1 were included in this meta-analysis.Inclusion criteriaRandomised controlled trials (RCTs) and non-randomised controlled trials that adopted ACCF and ACDF to treat two-adjacent-level CSM were included.ResultsNo significant differences were identified between the two groups regarding hospital stay, the Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) scores for neck and arm pain, total cervical range of motion (ROM), fusion ROM, fusion rate, adjacent-level ossification and complications, while ACDF had significantly less bleeding (SMD=1.14, 95% CI (0.74 to 1.53)); a shorter operation time (SMD=1.13, 95% CI (0.82 to 1.45)); greater cervical lordosis, total cervical (SMD=−2.95, 95% CI (−4.79 to −1.12)) and fused segment (SMD=−2.24, 95% CI (−3.31 to −1.17)); higher segmental height (SMD=−0.68, 95% CI (−1.03 to −0.34)) and less graft subsidence (SMD=0.40, 95% CI (0.06 to 0.75)) compared to ACCF.ConclusionsThe results suggested that ACDF has more advantages compared to ACCF. However, additional high-quality RCTs and a longer follow-up duration are needed.

Cervical Spondylotic Myelopathy: Pathophysiology and Surgical Approaches

“…In terms of cervical angle, ACCF increased the entire cervical lordotic angle postoperatively [16][17][18]25]. In elderly person, ACCF resulted in the same enhancement of cervical angle when compared with non-elderly [8].…”

“…ACDF improved the modified JOA scores and Nurick grades postoperatively [13,14]. Moreover, several studies reported that this technique provided higher postoperative JOA scores [9,[15][16][17][18][19]. In addition, this technique improved the pain symptom in the short term of follow-up [14,20,21].…”

“…In elderly person, ACCF resulted in the same enhancement of cervical angle when compared with non-elderly [8]. Furthermore, ACCF also increased the sagittal segmental angle [17,18,25]. In addition, Gao et al [25] reported that 2 levels ACCF provided more lordotic curve than 1 level ACCF.…”

“…Several studies showed that this technique increased the JOA score postoperatively in the mid-term of the follow-up [9,[15][16][17][18][19]25]. Lu et al [8] also reported a good clinical outcome of ACCF in the elderly population (70 years old).…”

“…The spinal fusion rate in ACCF was satisfied [9,15,17,18,25]. A retrospective study with a minimum of 5 years followup reported that the overall spinal fusion after ACCF was 96.6% [25].…”