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Anterior versus posterior approach for the therapy of multilevel cervical spondylotic myelopathy: a meta-analysis and systematic review

  • Long Zhang
  • Jia Chen
  • Can Cao
  • Ya-Zhou Zhang
  • Li-Fang Shi
  • Jin-Shuai Zhai
  • Teng Huang
  • Xi-Cheng LiEmail author
Orthopaedic Surgery
  • 10 Downloads

Abstract

Background

The goal of this meta-analysis is to explore the overall efficacy as well as the safety of anterior versus posterior approach for the therapy of patients with multilevel cervical spondylotic myelopathy based on qualified studies.

Methods

Three electronic databases, PubMed, Cochrane, Embase were searched updated to January 2018 to identify all relevant and qualified studies using the index words. The qualified studies were including prospective or retrospective comparative studies. Relative risk (RR) and mean difference (MD) along with 95% confidence interval (95% CI) were used to analyze the main outcomes.

Results

In this meta-analysis, there were a total of 24 studies with 959 patients in the anterior approach group and 1072 patients in the posterior approach group. The final results showed, in comparison of the posterior approach group, the anterior approach group significantly increased the JOA score (SMD: 0.36, 95% CI 0.10–0.62), the operation time (WMD: 49.87, 95% CI 17.67–82.08), and the neurological recovery rate (WMD: 10.55, 95% CI 3.99–17.11) with higher complication rate (RR: 1.53, 95% CI 1.24–1.89). Besides, there was no significant difference of the blood loss (SMD: − 0.40, 95% CI − 1.12 to 0.32) and ROM (SMD: − 0.28, 95% CI − 0.78 to − 0.22) between posterior approach group and anterior approach group.

Conclusions

Studies found a significant increase of JOA score as well as neurological recovery rate by the anterior approach treatment when compared with posterior approach treatment. However, increased operation time and complications could also occur through the anterior approach treatment. More high-quality randomized controlled trials with larger sample size, multi-centric and longer follow-ups are needed to support our current conclusions.

Keywords

Multilevel cervical spondylotic myelopathy Meta-analysis Anterior approach Posterior approach 

Notes

Funding

This study was supported by Key Research Projects in Medical Science (2007) (Grant no. 20170278).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of OrthopedicsHebei General HospitalShijiazhuangChina

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