Anterior Cervical Decompression and C5 Palsy: A Systematic Review and Meta-Analysis of Three Reconstructive Surgeries.
Anterior Cervical Decompression and C5 Palsy: A Systematic Review and Meta-Analysis of Three Reconstructive Surgeries.
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DOI：
10.1097/brs.0000000000003637
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发表时间：
2020-08
期刊：
影响因子：
3
通讯作者：
H. Takase;Katsuko Tayama;Yoshihiko Nakamura;R. Regenhardt;J. Mathew;Hidetoshi Murata;Tetsuya Yamamoto
中科院分区：
文献类型：
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作者：
H. Takase;Katsuko Tayama;Yoshihiko Nakamura;R. Regenhardt;J. Mathew;Hidetoshi Murata;Tetsuya Yamamoto
研究设计：对包括颈椎前路减压术后C5麻痹病例的文献进行系统回顾和荟萃分析。目的比较3种颈前路减压重建术式的疗效，并分析其迟发性C5神经麻痹及其他并发症的发生率。背景资料摘要迟发性C5麻痹是颈椎减压手术后众所周知的并发症。C5麻痹的病因已被研究，特别是后路手术后。然而，在前路手术中，由于程序的变化，一直缺乏研究。此外，关于外科手术中C5麻痹风险的证据有限。方法：我们对ACDF、ACCF及其组合（混合）的C5麻痹和其他并发症进行了广泛的文献检索。比较了这3种手术后C5麻痹的总体发生率，并通过使用比值比（OR）比较3组中2组的二元结局来研究特定优势（或优势）。结果26项研究符合纳入标准。共纳入3098例患者，其中5.8%发生C5麻痹。荟萃分析表明，ACDF的麻痹风险低于ACCF（OR; 0.36，95%置信区间[CI] 0.16-0.78），而ACDF与Hybrid（OR; 0.60，95%CI 0.24-1.51）和Hybrid与ACCF（OR; 1.11，95%CI 0.29-4.32）无显著差异。虽然在较短病变亚组中未观察到这些差异，但在较长病变亚组中，3种手术之间存在显著差异（p = 0.0005）。荟萃分析显示，在较长病变中，ACDF的发生率显著低于ACCF（OR; 0.42，95%CI 0.22-0.82）。此外，与ACCF相比，混合手术在麻痹发生率方面不劣于ACCF，并表明与ACCF相比，其他并发症发生率有降低的趋势。结论ACDF可能比Hybrid和ACCF产生更好的结果。此外，在手术并发症方面，Hybrid可能优于ACCF。证据等级3.
STUDY DESIGN A systematic review and meta-analysis were performed with the literature including the case of C5 palsy following anterior cervical decompression surgery. OBJECTIVE To compare 3 reconstructive procedures of anterior cervical decompression, the incidences of delayed C5 palsy and other complications were assessed. SUMMARY OF BACKGROUND DATA Delayed C5 palsy is now a well-known complication after cervical decompression surgery. The etiology of C5 palsy has been studied, especially after posterior surgery. However, in anterior surgery there has been a lack of investigation due to procedure variation. Additionally, limited evidence exists regarding the risk of C5 palsy in surgical procedures. METHODS We performed an extensive literature search for C5 palsy and other complications with ACDF, ACCF and their combination (Hybrid). Gross incidences of C5 palsy after these 3 procedures were compared, and specific superiorities (or inferiorities) were investigated via comparison of binary outcomes between 2 out of 3 groups using odds ratios (OR). RESULTS Twenty-six studies met the inclusion criteria. A total of 3098 patients were included and 5.8% of those developed C5 palsy. Meta-analyses demonstrated that ACDF had a lower risk of palsy than ACCF (OR; 0.36, 95% confidence interval[CI] 0.16-0.78), while ACDF vs Hybrid (OR; 0.60, 95%CI 0.24-1.51) and Hybrid vs ACCF (OR; 1.11, 95%CI 0.29-4.32) were not significantly different. Although these differences were not observed in shorter lesion subgroups, there were significant differences between the 3 procedures in longer lesion subgroups (p = 0.0005). Meta-analyses revealed that in longer lesions, ACDF had a significantly lower incidence than ACCF (OR; 0.42, 95%CI 0.22-0.82). Additionally, Hybrid surgery was non-inferior for palsy occurrence compared to ACCF, and suggested a trend for reduced rates of other complications compared to ACCF. CONCLUSIONS ACDF may yield better outcomes than Hybrid and ACCF. Furthermore, Hybrid may have advantages over ACCF in terms of surgical complications. LEVEL OF EVIDENCE 3.