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J Neurol Surg A Cent Eur Neurosurg 2023; 84(04): 343-354
DOI: 10.1055/s-0042-1747926
Original Article

Comparison of Complications between Anterior Cervical Diskectomy and Fusion versus Anterior Cervical Corpectomy and Fusion in Two- and Three-Level Cervical Spondylotic Myelopathy: A Meta-analysis

Zhentang Yu
1   Department of Orthopedics, The Affiliated Changzhou No. 2 People's Hospital with Nanjing Medical University, Changzhou, China
,
Xiaohan Shi
1   Department of Orthopedics, The Affiliated Changzhou No. 2 People's Hospital with Nanjing Medical University, Changzhou, China
,
Jianjian Yin
1   Department of Orthopedics, The Affiliated Changzhou No. 2 People's Hospital with Nanjing Medical University, Changzhou, China
,
Xijia Jiang
1   Department of Orthopedics, The Affiliated Changzhou No. 2 People's Hospital with Nanjing Medical University, Changzhou, China
,
Nanwei Xu
1   Department of Orthopedics, The Affiliated Changzhou No. 2 People's Hospital with Nanjing Medical University, Changzhou, China
› Author Affiliations Funding The present study was supported by the Project of Key Medical discipline of Jiangsu Province, Orthopedics (grant no. XK201603).
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Abstract

Background In this study, we systematically analyze the differences in complications between anterior cervical diskectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) in two- and three-level cervical spondylotic myelopathy (CSM).

Methods We performed a systematic search in MEDLINE, EMBASE, PubMed, Web of Science, Cochrane databases, Chinese Biomedical Literature Database, CNKI, and Wan Fang Data for all relevant studies. All statistical analyses were performed using Review Manager version 5.3.

Results A total of 11 articles with 849 study subjects were included, with 474 patients in the ACDF group and 375 patients in the ACCF group. The results of the meta-analysis showed that in C5 palsy (odds ratio [OR]: 0.41; 95% confidence interval [CI]: 0.16–1.06), pseudarthrosis (OR: 1.07; 95% CI: 0.23–5.07), dysphagia (OR: 1.06; 95% CI: 0.60–1.86), infection (OR: 0.41; 95% CI: 0.16–1.09), cerebrospinal fluid leakage (OR: 1.21; 95% CI: 0.39–3.73), graft dislodgment (OR: 0.28; 95% CI: 0.06–1.37), and hematoma (OR: 0.32; 95% CI: 0.06–1.83), there are no significant differences between the ACDF and ACCF groups, whereas total complication (OR: 0.50; 95% CI: 0.31–0.80) showed that the ACDF group had a significantly lower morbidity than the ACCF group. Furthermore, the three-level subgroup of ACDF had significantly better results in C5 palsy (OR: 0.31; 95% CI: 0.11–0.88), infection (OR: 0.22; 95% CI: 0.05–0.94), graft dislodgment (OR: 0.07; 95% CI: 0.01–0.40), and total complication (OR: 0.37; 95% CI: 0.23–0.60) compared with the ACCF subgroup.

Conclusion In general, postoperative pseudarthrosis, dysphagia, cerebrospinal fluid leakage, hematoma, C5 palsy, infection, and graft dislodgment did not differ significantly between the two groups. Total complication was significantly less in the ACDF group compared to the ACCF group. In the three-level subgroup, the morbidity of C5 palsy, infection, and graft dislodgment was significantly lower in ACDF than in ACCF.

Keywords

meta-analysis - anterior cervical diskectomy and fusion - anterior cervical corpectomy and fusion - ACDF - ACCF - multilevel cervical spondylotic myelopathy - MCSM

Ethical Approval

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


Informed Consent

Informed consent was obtained from all individual participants included in the study.




Publication History

Received: 22 May 2021

Accepted: 11 November 2021

Article published online:
01 July 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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