1
|
Chen L, Liu D, Wang M, Huang Y, Chen Z. Anterior Cervical Discectomy and Fusion with Zero-Profile Anchored Spacer Versus Plate and Cage for 3-Level Contiguous Cervical Degenerative Disease: A Systematic Review and Meta-Analysis. World Neurosurg 2024; 190:228-239. [PMID: 39033809 DOI: 10.1016/j.wneu.2024.07.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Accepted: 07/13/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVE To compare the safety, clinical outcomes, and radiological results of anterior cervical discectomy and fusion (ACDF) with zero-profile anchored spacer (ZPAS) versus plate and cage (PC) for 3-level contiguous cervical degenerative disease. METHODS The study was registered at PROSPERO (CRD42024512706). The Web of Science core collection, PubMed, and Embase were searched up to February 12, 2024. Review Manager 5.3 was used. The relative risk (RR) and 95% confidence interval were evaluated for dichotomous data. Continuous data were assessed using the mean difference and 95% confidence interval. RESULTS Nine studies comparing ACDF with ZPAS versus PC for 3-level contiguous cervical degenerative disease were included. The intraoperative blood loss and operation time in ZPAS were significantly less than those in PC. The subsidence rate, loss of cervical alignment, fusion segmental height, and intervertebral disc height were significantly greater in ZPAS than in PC. The cervical alignment and dysphagia rate within 6 months were significantly lower in ZPAS than in PC. The ASD of ZPAS was significantly lower than that of PC according to the sensitivity analysis when 1 study was excluded. No significant differences were identified in the other aspects. CONCLUSIONS Both ACDF with ZPAS and PC were safe and effective procedures. PC was associated with increased surgical trauma. The ZPAS could better decrease the incidence of ASD and dysphagia. ZPAS was also accompanied by high subsidence rate and poor cervical alignment.
Collapse
Affiliation(s)
- Li Chen
- Outpatient Blood Collection Center, West China Hospital, Sichuan University, Chengdu, China
| | - Dan Liu
- Outpatient Blood Collection Center, West China Hospital, Sichuan University, Chengdu, China
| | - Mingjiao Wang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Huang
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Zhen Chen
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China.
| |
Collapse
|
2
|
Meng H, Jin T, Wang J, Ji X, Peng Z, Qi M, Zhang C, Duan W, Chen Z. Comparison of Interbody Fusion Strategies in Anterior Cervical Discectomy and Fusion: A Network Meta-Analysis and Systematic Review. World Neurosurg 2024; 190:65-75. [PMID: 38942142 DOI: 10.1016/j.wneu.2024.06.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 06/21/2024] [Accepted: 06/22/2024] [Indexed: 06/30/2024]
Abstract
OBJECTIVE The optimal choice for fusion strategy in Anterior Cervical Discectomy and Fusion (ACDF) remains an unresolved issue. This study aims to perform a network meta-analysis and systematic review of fusion rate and complication rate of various fusion strategies used in ACDF. METHODS This study followed Prisma guidelines, and we searched PubMed, Embase, Cochrane Library, and Web of Science from inception to November 11, 2022, for Randomized Controlled trials comparing the efficacy and safety of fusion modalities in ACDF. The primary outcome was the fusion rate and complication rate. The PROSPERO number is CRD42022374440. RESULTS This meta-analysis identified 26 Randomized Controlled trial studies with 1789 patients across 15 fusion methods. The cage with autograft + plating showed the highest fusion rate, surpassing other methods like iliac crest bone graft (ICBG) and artificial bone graft (AFG). The stand-alone cage with autograft (SATG) had the second highest fusion rate. Regarding complication rate, the cage with AFG (CAFG) had the highest rate, more than other methods. The ICBG had a higher complication rate compared to ICBG + P, AFG, stand-alone cage with artificial bone graft, SATG, and CALG. The SATG performed well in both fusion and complication rate. CONCLUSIONS In this study, we conducted the first network meta-analysis to compare the efficacy and safety of various fusion methods in ACDF. Our findings suggest that SATG, with superior performance in fusion rate and complication rate, may be the optimal choice for ACDF. However, the results should be interpreted cautiously until additional research provides further evidence.
Collapse
Affiliation(s)
- Hongfeng Meng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Tianyu Jin
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Jialu Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Xiangtian Ji
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Zhiyuan Peng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Maoyang Qi
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Can Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Wanru Duan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Zan Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China.
| |
Collapse
|
3
|
Olivares-Camacho JL, Olivares Peña JL, Cuevas-Hernández AA, Hernández-Alcázar EDJ, Jiménez-Ponce F. Analyzing results of cervical sagittal parameters in patients operated with polyetheretherketone cages without plate. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2024; 15:230-235. [PMID: 38957757 PMCID: PMC11216644 DOI: 10.4103/jcvjs.jcvjs_35_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/27/2024] [Indexed: 07/04/2024] Open
Abstract
Study Design This was a retrospective longitudinal observational study. Purpose The purpose of this study was to analyze the results of cervical sagittal parameters on preoperative and postoperative lateral radiographs in anterior cervical discectomy and fusion (ACDF). ACDF is believed to change craniocervical parameters and thus cervical curvature using polyetheretherketone (PEEK) or titanium cages with or without self-locking as well as an anterior plate, the latter of which has not been shown to provide better clinical or radiological results. Overview of Literature Cervical spondylotic myelopathy (CSM) is a common degenerative pathology that can affect one or more levels and treatment has varied over time trying to maintain sagittal parameters within acceptable values where the ACDF is the main treatment. Materials and Methods The study was performed in patients with CSM who underwent anterior cervical discectomy, and their pre- and postoperative radiographs were analyzed using Surgimap software a few days before and 3 months after surgery. Results Fifteen files were included in the study. Statistically significant sagittal balance variables were observed in cervical lordosis (CL) with an increase of 4.73° (P = 0.019) and T1 slope (T1S)-CL with a decrease of -5.93° (P = 0.007). Conclusions CL and T1S-CL showed favorably modified values when performing ACDF using stand-alone PEEK cages without the need for self-blocking or an anterior plate.
Collapse
Affiliation(s)
| | - Jorge Luis Olivares Peña
- Department of Orthopaedic Surgery, Hospital Angeles Pedregal, Mexico City, Mexico
- Specialty Hospital ’’Dr. Antonio Fraga Mouret’’ of National Medical Center ’’La Raza’’, Mexico City, Mexico
| | - Aldo Adrián Cuevas-Hernández
- Higher School of Medicine of National Polytechnic Institute, Mexico City, Mexico
- Research Division, Hospital Angeles Pedregal, Mexico City, Mexico
| | - Edgar De Jesús Hernández-Alcázar
- Higher School of Medicine of National Polytechnic Institute, Mexico City, Mexico
- Research Division, Hospital Angeles Pedregal, Mexico City, Mexico
| | | |
Collapse
|
4
|
Aldahamsheh O, Alhammoud A, Halayqeh S, Jacobs WB, Thomas KC, Nicholls F, Evaniew N. Stand-Alone Anchored Spacer vs Anterior Plate Construct in the Management of Adjacent Segment Disease after Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis of Comparative Studies. Global Spine J 2024; 14:1038-1051. [PMID: 37705344 PMCID: PMC11192131 DOI: 10.1177/21925682231201787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
STUDY DESIGN Systematic Review and Meta-Analysis. OBJECTIVES This study aimed to evaluate the clinical and radiological outcomes of surgically treated adjacent segment disease (ASDis) following ACDF with either anterior plate construct (APC) or stand-alone anchored spacers (SAAS). METHOD Multiple databases were searched until December 2022 for pertinent studies. The primary outcome was health-related quality of life outcomes [JOA, NDI, and VAS], whereas, the secondary outcomes included operative characteristics [estimated blood loss (EBL) and operative time (OT)], radiological outcomes [C2-C7 Cobb angle, disc height index (DHI) changes, fusion rate], and complications. RESULTS A total of 5 studies were included, comprising 210 patients who had been surgically treated for cervical ASDis. Among them, 113 received APC, and 97 received SAAS. Postoperative dysphagia was significantly higher in the APC group [47% vs 11%, OR = 7.7, 95% CI = 3.1-18.9, P < .05]. Similarly, operative time and blood loss were higher in the APC group compared to the SAAS group; [MD = 16.96, 95% CI = 7.87-26.06, P < .05] and [MD = 5.22, 95% CI = .35 - 10.09, P < .05], respectively. However, there was no difference in the rate of prolonged dysphagia and clinical outcomes in terms of JOA, NDI, and VAS. Furthermore, there was no difference in the radiological parameters including the C2-7 Cobb angle and DHI as well as the fusion rate. CONCLUSION Our meta-analysis demonstrated that both surgical techniques (APC and SAAS) are effective in treating ASDis. However, with low certainty of the evidence, considering patients are at high risk of dysphagia following revision cervical spine surgery SAAS may be the preferred choice.
Collapse
Affiliation(s)
- Osama Aldahamsheh
- Division of Orthopedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, AB, Canada
- Department of Special Surgery, Orthopedic Surgery, Faculty of Medicine, Al- Balqa’ Applied University, Al-Salt, Jordan
| | - Abduljabbar Alhammoud
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | | | - W. Bradley Jacobs
- Division of Orthopedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Kenneth C. Thomas
- Division of Orthopedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Fred Nicholls
- Division of Orthopedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Nathan Evaniew
- Division of Orthopedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
5
|
Núñez JH, Escudero B, Montenegro JD, Jiménez-Jiménez MJ, Martínez-Peña J, Surroca M, Bosch-García D. [Translated article] Less superior adjacent syndrome and lower reoperation rate. Medium- and long-term results of cervical arthroplasty versus anterior cervical arthrodesis: Systematic review and meta-analysis of randomized clinical trials. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T168-T178. [PMID: 37995814 DOI: 10.1016/j.recot.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/26/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE To compare medium- and long-term postoperative surgical results, especially the adjacent syndrome rate, adverse event rate, and reoperation rate, of patients operated on with cervical arthroplasty or anterior cervical arthrodesis in published randomized clinical trials (RCTs), at one cervical level. METHODS Systematic review and meta-analysis. Thirteen RCTs were selected. The clinical, radiological and surgical results were analyzed, taking the adjacent syndrome rate and the reoperation rate as the primary objective of the study. RESULTS Two thousand nine hundred and sixty three patients were analyzed. The cervical arthroplasty group showed a lower rate of superior adjacent syndrome (P<0.001), lower reoperation rate (P<0.001), less radicular pain (P=0.002), and a better score of neck disability index (P=0.02) and SF-36 physical component (P=0.01). No significant differences were found in the lower adjacent syndrome rate, adverse event rate, neck pain scale, or SF-36 mental component. A range of motion of 7.91° was also found at final follow-up, and a heterotopic ossification rate of 9.67% in patients with cervical arthroplasty. CONCLUSION In the medium and long-term follow-up, cervical arthroplasty showed a lower rate of superior adjacent syndrome and a lower rate of reoperation. No statistically significant differences were found in the rate of inferior adjacent syndrome or in the rate of adverse events.
Collapse
Affiliation(s)
- J H Núñez
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), Spain; Unidad de Columna, Artro-Esport, Centro Médico Teknon, Barcelona, Spain.
| | - B Escudero
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), Spain
| | - J D Montenegro
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), Spain
| | - M J Jiménez-Jiménez
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), Spain
| | - J Martínez-Peña
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), Spain
| | - M Surroca
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), Spain
| | - D Bosch-García
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), Spain; Grup Traumatologic de Catalunya, Barcelona, Spain
| |
Collapse
|
6
|
Núñez JH, Escudero B, Montenegro JD, Jiménez-Jiménez MJ, Martínez-Peña J, Surroca M, Bosch-García D. Less superior adjacent syndrome and lower reoperation rate. Medium- and long-term results of cervical arthroplasty versus anterior cervical arthrodesis: Systematic review and meta-analysis of randomized clinical trials. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:168-178. [PMID: 37423383 DOI: 10.1016/j.recot.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/25/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023] Open
Abstract
OBJECTIVE To compare medium- and long-term postoperative surgical results, especially the adjacent syndrome rate, adverse event rate, and reoperation rate, of patients operated on with cervical arthroplasty or anterior cervical arthrodesis in published randomized clinical trials (RCTs), at one cervical level. METHODS Systematic review and meta-analysis. Thirteen RCTs were selected. The clinical, radiological and surgical results were analyzed, taking the adjacent syndrome rate and the reoperation rate as the primary objective of the study. RESULTS Two thousand nine hundred and sixty three patients were analyzed. The cervical arthroplasty group showed a lower rate of superior adjacent syndrome (P<0.001), lower reoperation rate (P<0.001), less radicular pain (P=0.002), and a better score of neck disability index (P=0.02) and SF-36 physical component (P=0.01). No significant differences were found in the lower adjacent syndrome rate, adverse event rate, neck pain scale, or SF-36 mental component. A range of motion of 7.91 degrees was also found at final follow-up, and a heterotopic ossification rate of 9.67% in patients with cervical arthroplasty. CONCLUSION In the medium and long-term follow-up, cervical arthroplasty showed a lower rate of superior adjacent syndrome and a lower rate of reoperation. No statistically significant differences were found in the rate of inferior adjacent syndrome or in the rate of adverse events.
Collapse
Affiliation(s)
- J H Núñez
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), España; Unidad de Columna, Artro-Esport, Centro Médico Teknon, Barcelona, España.
| | - B Escudero
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), España
| | - J D Montenegro
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), España
| | - M J Jiménez-Jiménez
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), España
| | - J Martínez-Peña
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), España
| | - M Surroca
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), España
| | - D Bosch-García
- Unidad de Columna Vertebral, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Tarrasa (Barcelona), España; Grup Traumatologic de Catalunya, Barcelona, España
| |
Collapse
|
7
|
Yuan H, Zhao Y, Hu Y, Liu Z, Chen Y, Wang H, Yu H, Xiang L. Risk Factors for Significant Intraoperative Blood Loss during Anterior Cervical Decompression and Fusion for Degenerative Cervical Diseases. Orthop Surg 2023; 15:2822-2829. [PMID: 37712097 PMCID: PMC10622266 DOI: 10.1111/os.13886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 08/12/2023] [Accepted: 08/15/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVES Anterior cervical decompression and fusion (ACF) has become a widely accepted surgical treatment for degenerative cervical diseases, but occasionally, significant intraoperative blood loss (SIBL), which is defined as IBL of 500 mL or more, will occur. We aimed to investigate the independent risk factors for SIBL during ACF for degenerative cervical diseases. METHODS We enrolled 1150 patients who underwent ACF for degenerative cervical diseases at our hospital between 2013 and 2019. The patients were divided into two groups: the SIBL group (n = 38) and the non-SIBL group (n = 1112). Demographic, surgical and radiographic data were recorded prospectively to investigate the independent risk factors for SIBL. For counting data, the chi-square test or Fisher's exact probability test was used. Student's t-test or the Mann-Whitney rank sum test was used for comparisons between groups of measurement data. Univariate analysis and multivariate logistic regression analysis were further used to analyze the significance of potential risk factors. RESULTS The incidence of SIBL during ACF was 3.3% (38/1150). A multivariate analysis revealed that female sex (odds ratio [OR], 6.285; 95% confidence interval [CI], 2.707-14.595; p < 0.001), corpectomy (OR, 3.872; 95% CI, 1.616-9.275; p = 0.002), duration of operation ≥150 min (OR, 8.899; 95% CI, 4.042-19.590; p < 0.001), C3 involvement (OR, 4.116; 95% CI, 1.808-9.369; p = 0.001) and ossification of posterior longitudinal ligament (OPLL) at the surgical level (OR, 6.007; 95% CI, 2.218-16.270; p < 0.001) were independent risk factors for SIBL. Patients with SIBL had more days of first-degree/intensive nursing (p = 0.003), longer length of stay (p = 0.003) and higher hospitalization costs (p = 0.023). CONCLUSION Female sex, corpectomy, duration of operation, C3 involvement and OPLL at the surgical level were independent risk factors for SIBL during ACF. SIBL in ACF was associated with more days of first-degree/intensive nursing, longer length of stay and higher hospitalization costs.
Collapse
Affiliation(s)
- Hong Yuan
- Department of OrthopaedicsGeneral Hospital of Northern Theater Command of Chinese PLAShenyangChina
| | - Yuanhang Zhao
- Department of OrthopaedicsGeneral Hospital of Northern Theater Command of Chinese PLAShenyangChina
| | - Yin Hu
- Department of OrthopaedicsGeneral Hospital of Northern Theater Command of Chinese PLAShenyangChina
| | - Zhonghua Liu
- Department of AnesthesiologyGeneral Hospital of Northern Theater Command of Chinese PLAShenyangChina
| | - Yu Chen
- Department of OrthopaedicsGeneral Hospital of Northern Theater Command of Chinese PLAShenyangChina
| | - Hongwei Wang
- Department of OrthopaedicsGeneral Hospital of Northern Theater Command of Chinese PLAShenyangChina
| | - Hailong Yu
- Department of OrthopaedicsGeneral Hospital of Northern Theater Command of Chinese PLAShenyangChina
| | - Liangbi Xiang
- Department of OrthopaedicsGeneral Hospital of Northern Theater Command of Chinese PLAShenyangChina
| |
Collapse
|
8
|
Su XJ, Chen XY, Dai JF, Zhu C, Song QX, Shen HX. Hybrid fixation versus conventional cage-plate construct in 3-level ACDF: Introduce the "seesaw theory" of stand-alone cage. Clin Neurol Neurosurg 2023; 233:107941. [PMID: 37573679 DOI: 10.1016/j.clineuro.2023.107941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/19/2023] [Accepted: 08/07/2023] [Indexed: 08/15/2023]
Abstract
STUDY DESIGN A retrospective study. BACKGROUND Conventional cage-plate construct (CCP) was widely used in anterior cervical discectomy and fusion (ACDF), but the rigid fixation limits the motion of fused segments. Self-locking stand-alone cage (SSC) was an alternative for ACDF procedures and showed several superiorities. However, the effect of hybrid fixation in 3-level ACDF remains unknown. OBJECTIVE To assess the clinical and radiological outcomes of hybrid fixation with SSC and CCP against conventional CCP in 3-level ACDF. METHOD A retrospective review of patients who underwent 3-level ACDF at Renji Hospital between January 2018 and December 2019 was performed. Eighty-three patients met the inclusion and exclusion criteria and were stratified into 2 groups based on the fixation methods. The clinical outcomes, functional outcomes, and radiological parameters were collected and analyzed. RESULTS No significant difference was observed between the two groups in the mean age, sex, body mass index, hospital stay, and duration of follow-up. The postoperative C2-7 Cobb angle in the CCP group was significantly greater than that in the hybrid group. The rate of cervical proximal junctional kyphosis (CPJK) in the hybrid group was significantly lower than that in the CCP group. The CCP group suffered significantly higher rates of adjacent segment degeneration (ASD) than the hybrid group at 2 years postoperatively. Moreover, the incidence of postoperative dysphagia was lower in the hybrid group. No significant differences were observed in JOA and NDI scores between the two groups. CONCLUSION The hybrid fixation achieved comparable clinical outcomes against CCP fixation, indicating that hybrid fixation is an alternative procedure in 3-level ACDF.
Collapse
Affiliation(s)
- Xin-Jin Su
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiu-Yuan Chen
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jia-Feng Dai
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chao Zhu
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qing-Xin Song
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Hong-Xing Shen
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| |
Collapse
|
9
|
Zhang Y, Ju J, Wu J. Zero-profile anchored spacer versus conventional plate-cage construct in bilevel anterior cervical discectomy and fusion: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:644. [PMID: 37653510 PMCID: PMC10469803 DOI: 10.1186/s13018-023-04134-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/24/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Zero-profile anchored spacers (ZAS) and plate-cage constructs (PCC) are currently employed when performing anterior cervical discectomy and fusion (ACDF). Nevertheless, the efficacy and safety of both devices in bilevel ACDF remain controversial. The goal of our meta-analysis is to assess the overall long-term efficacy and security among ZAS and PCC in bilevel ACDF. METHODS A search of four electronic databases was conducted to identify researches that compared ZAS with PCC for bilevel ACDF. Stata MP 17.0 software was used for this meta-analysis. RESULTS Nine researches with a total of 580 patients were involved. In comparison to PCC, ZAS significantly reduced intraoperative bleeding and postoperative dysphagia rates. No significant differences were found concerning operation time, JOA score, NDI score, cervical Cobb angle, fusion rates, the incidence of adjacent segmental degeneration (ASD) and implant sinking rates at last follow-up. CONCLUSION Compared to PCC, ZAS achieved similar efficacy and security in bilevel ACDF with respect to operative time, JOA score, NDI score, cervical Cobb angle, fusion rates, implant sinking rates and ASD rates at final follow-up. It is worth noting that ZAS offered considerable benefits over conventional PCC for the reduction of intraoperative bleeding and postoperative dysphagia. Therefore, for patients requiring bilevel ACDF, ZAS seems superior to PCC. Given the limitations of our study, larger prospective randomised controlled trials are needed to establish reliable proof to consolidate our conclusions.
Collapse
Affiliation(s)
- Yu Zhang
- Department of Orthopaedics, Jingjiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Jingjiang 214500, Taizhou, Jiangsu Province, China
| | - Jidong Ju
- Department of Orthopaedics, Jingjiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Jingjiang 214500, Taizhou, Jiangsu Province, China
| | - Jinchun Wu
- Department of Orthopaedics, Jingjiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Jingjiang 214500, Taizhou, Jiangsu Province, China.
| |
Collapse
|
10
|
Viswanathan VK, Muthu S. Is anterior cervical plating necessary for cage constructs in anterior cervical discectomy and fusion surgery for cervical degenerative disorders? Evidence-based on the systematic overview of meta-analyses. World Neurosurg X 2023; 18:100185. [PMID: 37008560 PMCID: PMC10064425 DOI: 10.1016/j.wnsx.2023.100185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/03/2023] [Accepted: 03/16/2023] [Indexed: 04/04/2023] Open
Abstract
Study design Systematic review of meta-analyses. Objective To perform a systematic review of meta-analyses to compare the clinical and radiological outcomes following anterior cervical discectomy and fusion with stand-alone cage (SAC) and anterior cervical cage-plate constructs (ACCPC). Methods The systematic overview was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and reported as per Cochrane Handbook for Systematic Reviews of Interventions following the methodology described in reporting Overview of reviews. Results Based on the available level-1 evidence, SAC offers significantly better benefits over ACCPC, in terms of shorter operative time (p < 0.00001; I2 = 0%), lower blood loss (p = 0.01; I2 = 0%), lesser rates of post-operative dysphagia (p = 0.02; I2 = 0%), reduced overall expenditure (p = 0.001) and long-term adjacent segment degeneration (ASD)/anterior longitudinal ligament ossification (ALO; p = 0.0003; I2 = 0%). There is no significant difference between the two constructs with regard to fusion rates, functional outcome scores, follow-up radiological sagittal alignment parameters or cage subsidence. Conclusion Based on the available evidence, SAC constructs in ACDF reduce blood loss, decreases operative time, mitigates post-operative dysphagia, lessens hospital-related expenditure and minimises long-term ASD rates.
Collapse
Affiliation(s)
- Vibhu Krishnan Viswanathan
- Department of Musculoskeletal Oncology, University of Calgary, Alberta, Canada
- Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
| | - Sathish Muthu
- Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
- Department of Orthopaedics, Government Medical College, Dindigul, India
- Corresponding author. Research Head, Orthopaedic Research Group, Coimbatore, Tamil Nadu, India.
| |
Collapse
|
11
|
Changes in cervical alignment of Zero-profile device versus conventional cage-plate construct after anterior cervical discectomy and fusion: a meta-analysis. J Orthop Surg Res 2022; 17:510. [PMID: 36434715 PMCID: PMC9694539 DOI: 10.1186/s13018-022-03400-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/11/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Anterior cervical diskectomy and fusion (ACDF) has been widely accepted as a gold standard for patients with cervical spondylotic myelopathy (CSM). However, there was insufficient evidence to compare the changes in the cervical alignment with different fusion devices in a long follow-up period. This meta-analysis was performed to compare the radiologic outcomes and loss of correction (LOC) in cervical alignment of Zero-profile (ZP) device versus cage-plate (CP) construct for the treatment of CSM. METHODS Retrospective and prospective studies directly comparing the outcomes between the ZP device and CP construct in ACDF were included. Data extraction was conducted and study quality was assessed independently. A meta-analysis was carried out by using fixed effects and random effects models to calculate the odds ratio and mean difference in the ZP group and the CP group. RESULTS Fourteen trials with a total of 1067 participants were identified. ZP group had a lower rate of postoperative dysphagia at the 2- or 3-month and 6-month follow-up than CP group, and ZP group was associated with a decreased ASD rate at the last follow-up when compared with the CP group. The pooled data of radiologic outcomes revealed that there was no significant difference in postoperative and last follow-up IDH. However, postoperative and last follow-up cervical Cobb angle was significantly smaller in the ZP group when compared with the CP group. In subgroup analyses, when the length of the last follow-up was less than 3 years, there was no difference between two groups. However, as the last follow-up time increased, cervical Cobb angle was significantly lower in the ZP group when compared with the CP group. CONCLUSION Based on the results of our analysis, the application of ZP device in ACDF had a lower rate of postoperative dysphagia and ASD than CP construct. Both devices were safe in anterior cervical surgeries, and they had similar efficacy in correcting radiologic outcomes. However, as the last follow-up time increased, ZP group showed greater changes cervical alignment. In order to clarify the specific significance of LOC, additional large clinical studies with longer follow-up period are required.
Collapse
|
12
|
Núñez JH, Escudero B, Omiste I, Martínez-Peñas J, Surroca M, Alonzo-González F, Bosch-García D. Outcomes of cervical arthroplasty versus anterior cervical arthrodesis: a systematic review and meta-analysis of randomized clinical trials with a minimum follow-up of 7-year. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03365-1. [PMID: 35986813 DOI: 10.1007/s00590-022-03365-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Compare the outcomes of randomized clinical trials of cervical disc arthroplasty (CDA) versus anterior cervical discectomy with fusion (ACDF), with a minimum follow-up of 7 years. METHODS Nine randomized clinical trials were selected. The clinical, radiological, and surgical outcomes were analyzed, including functional and pain scores, range of motion, adjacent segment degeneration, adverse events, and need for reoperation. RESULTS 2664 patients were included in the study. Pooled results indicated that the CDA group had a significantly higher overall success rate (p < 0.001), a higher improvement in the neck disability index (NDI) (p = 0.002), less VAS arm pain (p = 0.01), and better health questionnaire SF-36 physical component (p = 0.01) than ACDF group. Likewise, the pooled results indicated a significantly higher motion rate (p < 0.001), less adjacent syndrome (p < 0.05), and a lower percentage of reoperation (p < 0.001) in the CDA group. There were no significant differences between the CDA and ACDF groups in the neck pain scale (p = 0.11), the health questionnaire SF-36 mental component (p = 0.10), and in adverse events (p = 0.42). CONCLUSION In long-term follow-up, CDA showed a better overall success rate, better improvement in NDI, less VAS arm pain, better health questionnaire SF-36 physical component, a higher motion rate, less adjacent syndrome, and less reoperation rate than ACDF. No significant differences were found in the neck pain scale, SF-36 mental component, and in adverse events.
Collapse
Affiliation(s)
- Jorge H Núñez
- Spine Unit, Department of Traumatology and Orthopedic Surgery, University Hospital of Mutua Terrassa, Plaça del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain.
- Spine Unit, Artro-Esport, Centro Médico Teknon, Carrer de Vilana, 12, 08022, Barcelona, Spain.
| | - Berta Escudero
- Spine Unit, Department of Traumatology and Orthopedic Surgery, University Hospital of Mutua Terrassa, Plaça del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain
| | - Irene Omiste
- Spine Unit, Department of Traumatology and Orthopedic Surgery, University Hospital of Mutua Terrassa, Plaça del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain
| | - Judith Martínez-Peñas
- Spine Unit, Department of Traumatology and Orthopedic Surgery, University Hospital of Mutua Terrassa, Plaça del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain
| | - Maria Surroca
- Spine Unit, Department of Traumatology and Orthopedic Surgery, University Hospital of Mutua Terrassa, Plaça del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain
| | - Francisco Alonzo-González
- Hospital Ceibal de Accidentes Del Instituto Guatemalteco de Seguridad Social, Cuidad de Guatemala, Guatemala
| | - David Bosch-García
- Spine Unit, Department of Traumatology and Orthopedic Surgery, University Hospital of Mutua Terrassa, Plaça del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain
- Grup Traumatologic de Catalunya, Barcelona, Spain
| |
Collapse
|
13
|
Bohl M, Kakarla UK, Chang SW, Sethi R, Farrokhi F, Leveque JC. Establishing a Reference Procedure Length for Anterior Cervical Fusions: The Role for Standards in Surgical Process Improvement. Cureus 2022; 14:e22615. [PMID: 35371809 PMCID: PMC8958152 DOI: 10.7759/cureus.22615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2022] [Indexed: 11/24/2022] Open
Abstract
Surgical process improvement strategies are increasingly being applied to specific procedures to improve value. A critical step in any process improvement strategy is the identification of performance benchmarks. Procedure length is a performance benchmark for anterior cervical discectomy and fusion (ACDF) procedures; therefore, we sought to establish reference procedure lengths for 1-level, 2-level, and 3-level ACDFs at both teaching and non-teaching institutions and to describe methods for using this information to advance surgical process improvement initiatives. We performed a retrospective analysis of consecutive ACDFs performed at a resident teaching institution (RT) and a non-teaching institution (NT) for all 1-level, 2-level, and 3-level ACDFs. Mean case lengths and patient outcomes were calculated for individual surgeons and institutions. After limiting cases to 1-level, 2-level, and 3-level ACDFs and applying all exclusion criteria, 991 cases at the RT institution and 131 cases at the NT institution (a total of 1122 cases) were available for analysis. The mean (SD) procedure length for 1-level, 2-level, and 3-level ACDFs at the RT versus NT institutions were 121.9 min (36.3 min) and 73.6 min (29.7 min) (p<0.001), 172.7 min (44.8 min) and 112.0 min (43.0 min) (p<0.001), and 218.3 min (54.9 min) and 167.6 min (54.2 min) (p<0.001), respectively. Thirty-day outcomes were the same between institutions, except that the RT institution had a shorter mean hospital length of stay for 2-level ACDFs (1.6 days versus 2.9 days, p=0.001). This study is the first to attempt to establish a standard reference procedure length for 1-level, 2-level, and 3-level ACDFs. These data can guide efforts in surgical process improvement.
Collapse
|
14
|
Liang Y, Xu S, Yu G, Zhu Z, Liu H. Cervical spine alignment and clinical outcomes after multilevel anterior cervical decompression and fusion with or without plate: A minimal 5-year follow-up of a CONSORT-compliant article. Medicine (Baltimore) 2021; 100:e26126. [PMID: 34397682 PMCID: PMC8322561 DOI: 10.1097/md.0000000000026126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 05/08/2021] [Indexed: 01/04/2023] Open
Abstract
It was reported imperative on cervical sagittal alignment reconstruction after anterior multilevel procedures with self-locked stand-alone cage (SSC) or anterior cage-with-plate (ACP) system multilevel while there was little knowledge about the relationship on cervical alignment and clinical outcomes.To identify the importance of cervical sagittal alignment after 3-level anterior cervical discectomy and fusion on cervical spondylotic myelopathy with SSC and ACP system.Seventy-seven patients with SSC system (SSC group) and 52 cases with ACP system (ACP group) from February 2007 to September 2013 were enrolled with well-matched demographics. Cervical alignment included C2-7 lordosis (CL), operated-segment cervical lordosis (OPCL), upper and lower adjacent-segment cervical lordosis, range of motion of upper and lower adjacent segment at preoperation, immediate postoperation, and the final follow-up. Clinical outcomes contained the neck disability index (NDI), the Japanese Orthopaedic Association (JOA) score, visual analogous scale (VAS) of arm and neck and adjacent segment degeneration (ASD). Patients were then divided into CL improved subgroup (IM subgroup) and non-improved subgroup (NIM subgroup).There were improvements on CL and OPCL in both groups. The change of CL and OPCL larger in ACP group (P < .05) but upper adjacent-segment cervical lordosis/lower adjacent-segment cervical lordosis and range of motion of upper adjacent segment/range of motion of lower adjacent segment were of no significance. NDI, JOA, and VAS got improvement in both groups at immediate postoperation and the final follow-up while ASD was in no difference between SSC and ACP group. A total of 80 patients (39 vs 41) acquired CL improvement with a larger population in ACP group. There were no differences on the rate of ASD, NDI, JOA, VAS, and their change between IM and NIM subgroup. The changes of CL were not correlated to NDI, JOA, VAS, and their change.SSC and ACP group both provide improved OPCL and efficacy on 3-level cervical spondylotic myelopathy with little impact on adjacent segment. The change of CL is not correlated to clinical outcomes.
Collapse
|
15
|
Fayed I, Conte AG, Keating G, Cobourn KD, Altshuler M, Makariou E, Spitz SM, Anaizi AN, Nair MN, Voyadzis JM, Sandhu FA. Comparison of Clinical and Radiographic Outcomes After Standalone Versus Cage and Plate Constructs for Anterior Cervical Discectomy and Fusion. Int J Spine Surg 2021; 15:403-412. [PMID: 33963034 DOI: 10.14444/8060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Anterior cervical discectomy and fusion (ACDF) has conventionally been performed using an allograft cage with a plate-and-screw construct. Recently, standalone cages have gained popularity due to theorized decreases in operative time and postoperative dysphagia. Few studies have compared these outcomes. Here, we directly compare the outcomes of plated versus standalone ACDF constructs. METHODS A single-center retrospective review of patients undergoing ACDF after June 2011 with at least 6 months of follow up was conducted. Clinical outcomes were analyzed and compared between standalone and plated constructs. Multivariate regression analysis of the primary outcome, need for revision surgery, as well as several secondary outcomes, procedure duration, estimated blood loss (EBL), length of hospital stay, disposition, and incidence of dysphagia, hoarseness, or surgical site infection, was completed. RESULTS A total of 321 patients underwent ACDF and met inclusion-exclusion criteria, with mean follow-up duration of 20 months. Forty-six (14.3%) patients received standalone constructs, while 275 (85.7%) received plated constructs. Fourteen (4.4%) total revisions were necessary, 4 in the standalone group and 10 in the plated group, yielding revision rates of 8.7% and 3.6%, respectively (P = .125). Mean EBL was 98 mL in the standalone group and 63 mL in the plated group (P = .001). Mean procedure duration was 147 minutes in the standalone group and 151 minutes in the plated group (P = .800). Mean hospital stay was 3.6 days in the standalone group and 2.5 days in the plated group (P = .270). There was no significant difference in incidence of dysphagia (P = .700) or hoarseness (P = .700). CONCLUSIONS Standalone ACDF demonstrates higher, but not statistically significant, revision rates than plate-and-screw constructs, without the hypothesized decreased incidence of dysphagia or hoarseness and without decreased procedure duration or EBL. Surgeons may consider limiting use of these constructs to cases of adjacent segment disease. Larger studies with longer follow up are necessary to make more definitive conclusions. LEVEL OF EVIDENCE 4. CLINICAL RELEVANCE This study will help spine surgeons decide between using standalone or cage-and-plate constructs for ACDF.
Collapse
Affiliation(s)
- Islam Fayed
- MedStar Georgetown University Hospital, Department of Neurosurgery, Washington, DC
| | - Anthony G Conte
- MedStar Georgetown University Hospital, Department of Neurosurgery, Washington, DC
| | | | - Kelsey D Cobourn
- MedStar Georgetown University Hospital, Department of Neurosurgery, Washington, DC
| | | | - Erini Makariou
- MedStar Georgetown University Hospital, Department of Radiology, Washington, DC
| | - Steven M Spitz
- MedStar Georgetown University Hospital, Department of Neurosurgery, Washington, DC
| | - Amjad N Anaizi
- MedStar Georgetown University Hospital, Department of Neurosurgery, Washington, DC
| | - M Nathan Nair
- MedStar Georgetown University Hospital, Department of Neurosurgery, Washington, DC
| | - Jean-Marc Voyadzis
- MedStar Georgetown University Hospital, Department of Neurosurgery, Washington, DC
| | - Faheem A Sandhu
- MedStar Georgetown University Hospital, Department of Neurosurgery, Washington, DC
| |
Collapse
|
16
|
Locking stand-alone cage versus anterior plate construct in anterior cervical discectomy and fusion: a systematic review and meta-analysis based on randomized controlled trials. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:2734-2744. [PMID: 32770359 DOI: 10.1007/s00586-020-06561-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 06/15/2020] [Accepted: 08/02/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate the efficacy of locking stand-alone cage (LSC) compared with anterior plate construct (APC) in anterior cervical discectomy and fusion (ACDF). METHODS A comprehensive literature search was carried out in PubMed, Embase, Web of Science, and Cochrane Library to screen randomized controlled trials (RCTs) that directly compared LSC with APC in ACDF. The Cochrane Collaboration's tool was used for assessment of study quality. Data were analyzed with the Review Manager 5.3 software. RESULTS A total of seven RCTs were included. The results revealed no significant differences between LSC and APC in ACDF regarding the fusion rate, Japanese Orthopaedic Association score, visual analogue scale score, neck disability index score, hospital stay, subsidence rate, cervical lordosis, segmental Cobb angle, and disc height. However, LSC was associated with a significantly shorter operation time, less blood loss, lower overall incidence of dysphagia, and lower adjacent-level ossification (ALO) rate compared with APC. CONCLUSION In summary, LSC is not only a safe and effective device for ACDF but also has the advantages of significantly reduced operation time, blood loss, overall incidence of dysphagia, and ALO rate over APC. Therefore, LSC is a better alternative than APC for the patients undergoing ACDF procedures.
Collapse
|
17
|
Making the Most of Systematic Reviews and Meta-analyses in Spine Surgery: A Primer for the Practicing Spine Surgeon. Spine (Phila Pa 1976) 2020; 45:E808-E812. [PMID: 32539294 DOI: 10.1097/brs.0000000000003429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Review. OBJECTIVE To provide practicing spine surgeons a primer with key insights for reading, interpreting, and clinically integrating systematic reviews and meta-analyses. SUMMARY OF BACKGROUND DATA Evidence-based medicine (EBM) refers to a family of standardized techniques for critical appraisal of clinical research. Within the contemporary spine literature, EBM is most commonly encountered in the form of systematic reviews and meta-analyses. Although these analytic techniques are potentially useful when appropriately applied to well-formulated questions with adequate primary data in the literature, the rapid and somewhat indiscriminate increase in volume of systematic reviews and meta-analyses published may be associated with an overall dilution in their quality, as well as misperceptions regarding the applicability of particular EBM studies to spine surgery in general. METHODS The collective experience of spine specialists with vested interests in advancing EBM and its utility was summarized into a primer. RESULTS We emphasize components that are pertinent methodologically (search strategy, study number, meta-analysis, bias, and certainty), and pertinent clinically (outcomes) to interpreting, and clinically integrating systematic reviews and meta-analyses into spine surgery practice. CONCLUSIONS Armed with these insights into these five perspectives, we anticipate that practicing spine surgeons will be better equipped to interpret systematic reviews and meta-analyses in a fashion that will meaningfully impact their patient care. LEVEL OF EVIDENCE 2.
Collapse
|
18
|
Zhang Y, Lv N, He F, Pi B, Liu H, Chen AC, Yang H, Liu M, Zhu X. Comparison of cervical disc arthroplasty and anterior cervical discectomy and fusion for the treatment of cervical disc degenerative diseases on the basis of more than 60 months of follow-up: a systematic review and meta-analysis. BMC Neurol 2020; 20:143. [PMID: 32312321 PMCID: PMC7171870 DOI: 10.1186/s12883-020-01717-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 04/02/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND This meta-analysis was designed to investigate the long-term efficacy and safety between cervical disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF) in treating cervical disc degenerative diseases (CDDDs). METHODS Literature search was performed on Pubmed, Embase, Cochrane Library, and Web of Science before Jan 2019. Surgical details, clinical outcomes, range of motion (ROM), complications, and reoperation rates between CDA and ACDF groups were compared and analyzed. A fixed- or random-effects model was applied based on different heterogeneity. STATA (Version 11.0) software was used to perform data analysis. RESULTS A total of 13 randomized controlled trial studies with more than 60 months of follow-up (mean 83.1 months) were enrolled in this meta-analysis. Pool results indicated that the CDA group exhibited significantly better outcomes in clinical scores (odds ratio [OR] = 1.54, 95% confidence interval [CI]: 1.15-2.08, p = 0.004) and preservation of ROM (mean difference = 1.77, 95% CI: 1.60-1.95, p < 0.001) than the ACDF group. Meanwhile, the incidence of adjacent segment disease (ASD) (OR = 0.51, 95% CI: 0.35-0.76, p = 0.001) and occurrence of reoperation (OR = 0.41, 95% CI: 0.25-0.69, p = 0.001) were lower in the CDA group than in the ACDF group. CONCLUSIONS At long-term follow-up, CDA showed better efficacy in terms of clinical outcomes, ROM, ASD, and reoperation than ACDF for treating CDDDs. However, our results require further validation in large-sample and high-quality studies.
Collapse
Affiliation(s)
- Yijian Zhang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, Pinghai Road, Suzhou, 215006, China.,Orthopedic Institute, Soochow University, Suzhou, 215006, China
| | - Nanning Lv
- Department of Orthopedic Surgery, The Second People's Hospital of Lianyungang, Lianyungang, 222003, Jiangsu, China
| | - Fan He
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, Pinghai Road, Suzhou, 215006, China.,Orthopedic Institute, Soochow University, Suzhou, 215006, China
| | - Bin Pi
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, Pinghai Road, Suzhou, 215006, China.,Orthopedic Institute, Soochow University, Suzhou, 215006, China
| | - Hao Liu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, Pinghai Road, Suzhou, 215006, China.,Orthopedic Institute, Soochow University, Suzhou, 215006, China
| | - Angela Carley Chen
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada
| | - Huilin Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, Pinghai Road, Suzhou, 215006, China.,Orthopedic Institute, Soochow University, Suzhou, 215006, China
| | - Mingming Liu
- Department of Orthopedic Surgery, The Second People's Hospital of Lianyungang, Lianyungang, 222003, Jiangsu, China.
| | - Xuesong Zhu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, Pinghai Road, Suzhou, 215006, China. .,Orthopedic Institute, Soochow University, Suzhou, 215006, China.
| |
Collapse
|