Dan Huang1, Xuelian Du2, Huiting Liang3, Wenjie Hu4, Haijun Hu1, Xing Cheng5. 1. Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, People's Republic of China. 2. The Faculty of Medical Imaging, The Medical College of Nanchang University, Nanchang 330006, People's Republic of China. 3. Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, People's Republic of China. 4. Department of Ophthalmology, ZhongShan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510080, People's Republic of China. Electronic address: 1169954245@qq.com. 5. Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, People's Republic of China. Electronic address: xingcheng910129@163.com.
Abstract
PURPOSE: To compare the effectiveness between anterior corpectomy (CORP) and posterior laminoplasty (LAMP) for the treatment of multilevel cervical myelopathy. STUDY DESIGN: Systematic review and meta-analysis. METHODS: We searched MEDLINE, EMBASE, PubMed, OVID, Web of Science and the Cochrane Central Register of Controlled Trials databases for all relevant articles that compared the two operations for the treatment of multilevel cervical myelopathy. Exclusion criteria were non-controlled studies, combined anterior and posterior surgery, follow-up <1 year and patients with tumors, trauma, soft disc herniation or previous surgery. The following outcome measures were extracted: Japanese orthopedic association (JOA) score, neurological recovery rate, surgical complications, reoperation rate, operation time and blood loss. RESULTS: 7 high quality studies were included in the meta-analysis. There was no significant difference in preoperative JOA score [P > 0.05, WMD 0.31 (-0.16, 0.79)] and complication rate [P > 0.05, OR 1.26 (0.82,1.94)] between the two groups. Significant less reoperation rate [P < 0.05, OR 8.16 (3.10, 21.51)], operation time [P < 0.05, WMD 67.94 (50.69, 85.20)] and blood loss [P < 0.05, WMD 170.06 (80.05, 260.08)] were found in posterior LAMP group. Whereas, patients in anterior CORP group obtained a better postoperative JOA score [P < 0.05, WMD 2.02 (1.61, 2.43)] and neurological recovery rate [P < 0.05, WMD 7.22 (0.36,14.08)] than that in posterior LAMP group. CONCLUSIONS: Anterior CORP has a higher postoperative JOA score and neurological recovery rate compared with posterior LAMP. However, significant higher reoperation rate, operation time and blood loss should be taken into consideration when anterior CORP is used. High-quality RCTs with long-term follow-up and large sample size are needed.
PURPOSE: To compare the effectiveness between anterior corpectomy (CORP) and posterior laminoplasty (LAMP) for the treatment of multilevel cervical myelopathy. STUDY DESIGN: Systematic review and meta-analysis. METHODS: We searched MEDLINE, EMBASE, PubMed, OVID, Web of Science and the Cochrane Central Register of Controlled Trials databases for all relevant articles that compared the two operations for the treatment of multilevel cervical myelopathy. Exclusion criteria were non-controlled studies, combined anterior and posterior surgery, follow-up <1 year and patients with tumors, trauma, soft disc herniation or previous surgery. The following outcome measures were extracted: Japanese orthopedic association (JOA) score, neurological recovery rate, surgical complications, reoperation rate, operation time and blood loss. RESULTS: 7 high quality studies were included in the meta-analysis. There was no significant difference in preoperative JOA score [P > 0.05, WMD 0.31 (-0.16, 0.79)] and complication rate [P > 0.05, OR 1.26 (0.82,1.94)] between the two groups. Significant less reoperation rate [P < 0.05, OR 8.16 (3.10, 21.51)], operation time [P < 0.05, WMD 67.94 (50.69, 85.20)] and blood loss [P < 0.05, WMD 170.06 (80.05, 260.08)] were found in posterior LAMP group. Whereas, patients in anterior CORP group obtained a better postoperative JOA score [P < 0.05, WMD 2.02 (1.61, 2.43)] and neurological recovery rate [P < 0.05, WMD 7.22 (0.36,14.08)] than that in posterior LAMP group. CONCLUSIONS: Anterior CORP has a higher postoperative JOA score and neurological recovery rate compared with posterior LAMP. However, significant higher reoperation rate, operation time and blood loss should be taken into consideration when anterior CORP is used. High-quality RCTs with long-term follow-up and large sample size are needed.