Outcomes of posterior cervical fusion and decompression: a systematic review and meta-analysis

Abstract

BACKGROUND CONTEXT: Posterior cervical fusion (PCF) with decompression is a treatment option for patients with conditions such as spondylosis, spinal stenosis, and degenerative disc disorders that result in myelopathy or radiculopathy. The annual rate, number, and cost of PCF in the United States has increased. Far fewer studies have been published on PCF outcomes than on anterior cervical fusion (ACF) outcomes, most likely because far fewer PCFs than ACFs are performed. PURPOSE: To evaluate the patient-reported and clinical outcomes of adult patients who underwent subaxial posterior cervical fusion with decompression. STUDY DESIGN/SETTING: Systematic review and meta-analysis. PATIENT SAMPLE: The total number of patients in the 31 articles reviewed and included in the meta-analysis was 1,238 (range 7−166). OUTCOME MEASURES: Preoperative to postoperative change in patient-reported outcomes (visual analog scales for arm pain and neck pain, Neck Disability Index, Japanese Orthopaedic Association [JOA] score, modified JOA score, and Nurick pain scale) and rates of fusion, revision, and complications or adverse events. METHODS: This study was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and a preapproved protocol. PubMed and Embase databases were searched for articles published from January 2001 through July 2018. Statistical analyses for patient-reported outcomes were performed on the outcomes' raw mean differences, calculated as postoperative value minus preoperative value from each study. Pooled rates of successful fusion, revision surgery, and complications or adverse events, and their 95% confidence FDA device/drug status: Not applicable.

The Advent of Spinoplastics: Easing the Growing Global Disease Burden of Spinal Injury

“…28 A systematic review of cervical fusion surgeries indicates statistically significant improvements in all patient-reported outcome measures: the visual analog scale for arm pain, the visual analog scale for neck pain, Neck Disability Index, Japanese Orthopaedic Association score, and Nurick pain scale. 53 Pooled outcomes of cervical fusions reveal a success rate of 98.25%, with nearly 10% of patients reporting complications or adverse events. 53 Complications commonly reported in the setting of cervical decompression fusion surgery include axial pain, C5 palsy, wound infection, and transient worsening of preoperative neurologic symptoms.…”

“…53 Pooled outcomes of cervical fusions reveal a success rate of 98.25%, with nearly 10% of patients reporting complications or adverse events. 53 Complications commonly reported in the setting of cervical decompression fusion surgery include axial pain, C5 palsy, wound infection, and transient worsening of preoperative neurologic symptoms. Direct comparison of cervical fusion techniques shows no difference in complication rate between ACDF and hybrid fusions; however, there are significantly lower complication rates in the hybrid fusion compared with ACCF.…”

Posteriore Dekompressionstechniken an der Halswirbelsäule bei spondylogener zervikaler Myelopathie

“…Über die Häufigkeit von Komplikationen bei Eingriffen an der Halswirbelsäule wurde bereits viel veröffentlicht. Allerdings weichen die Angaben von Studie zu Studie erheblich voneinander ab: Gesamtkomplikationsraten von 0 bis 49 % werden angegeben [13]. Ein Grund ist die unterschiedliche Art der Registrierung: bekannt ist, dass bei prospektiver Komplikationserfassung eine wesentlich höhere Anzahl von unerwünschten Ereignissen erfasst wird [14].…”

Autologous Stem Cells in Cervical Spine Fusion

“…Of note, donor site complications in the intervention group included a 40% rate of persistent pain and a 2% incidence of hematoma. 29 A 2019 systematic review and meta-analysis by Youssef et al 50 found a 9.0% rate of all-cause complications in the setting of posterior cervical surgery. With use of BMA, Epstein et al 33 demonstrated a 3% rate of revision at 6 months, and 3% rate of transient bilateral C5 palsy, which ultimately recovered.…”