In the absence of significant retrovertebral disease, ACDF is the preferred treatment. However future studies with high methodological quality and long-term follow-up periods are needed for updated meta-analyses, in order to better evaluate the two procedures for CSM treatment. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Results Of citations examined, 15 articles representing participants were eligible. Funding: The authors have no support or funding to report.
Introduction Cervical spondylotic myelopathy CSM is a clinically symptomatic condition caused by compression of the spinal cord due to degeneration. Methods 2. Download: PPT. Results 3. Table 2. Details and heterogeneity of clinical outcome measurement of the included studies.
Table 4. Quality assessment according to the Newcastle—Ottawa scale of the included studies. Figure 2. Figure 3. Figure 4. Figure 5. Figure 6. Figure 7. Figure 8. Figure 9. Figure Discussion Although the surgical treatment for cervical spondylotic myelopathy CSM has a history going back sixty years, the selection of surgical procedures remains controversial and challenging. Supporting Information. Checklist S1. References 1. Cervical radiculopathy. N Engl J Med — View Article Google Scholar 2.
J Bone Joint Surg Am — View Article Google Scholar 3. Spine Phila Pa — View Article Google Scholar 4. Neurol Clin — View Article Google Scholar 5. HSS J 7: — View Article Google Scholar 6. Young WF Cervical spondylotic myelopathy: a common cause of spinal cord dysfunction in older persons. Am Fam Physician : —, Surg Neurol 4—5.
Obviously, ACDF can offer more fixation points to hold the construct rigidly in place, but ACCF provides only 2 points of fixation, which can explain the reason that more graft-related problems occur in the ACCF group.
Previous meta-analyses [ 46 , 47 ] showed that fusion rate between the 2 groups was not significantly different, which is in contrast to our result. Considering some flaws mentioned above in previous meta-analyses, [ 46 , 47 ] we regard the fusion rate was better in ACDF. We selected blood loss, operation time, and complication-related outcomes to evaluate surgical outcomes and found that ACDF have better results in blood loss, C5plasy, and total complications, whereas other variables including operation time, dysphagia, hoarseness, infection, cerebral fluid leakage, donor site pain, epidural hematoma, and pseudoarthrosis were similar between the 2 groups.
C5 palsy is considered as an important complication after cervical decompression surgery. Sakaura et al [ 67 ] reported the average incidence was 4. There were similar rates of dysphagia and hoarseness in both the groups.
Dysphagia and hoarseness were common complications after multilevel anterior cervical surgery, [ 68 ] which may be caused by trachea and esophagus traction. There are several limitations of this study. Second, the statistical power could be improved in the future by including more studies.
Due to the small number of included studies, some parameters could not be analyzed by subgroups to avoid a high heterogeneity, which may exert instability on the consistency of the outcomes.
Third, the follow-up of all included article was up to 2 years, which was not enough to observe the long-term recovery and complications. Fourth, the searching strategy was restricted to articles published in English and Chinese languages.
Articles with potentially high-quality data that were published in other languages were not included because of anticipated difficulties in obtaining accurate medical translations. So in radiographic outcomes at the final follow-up Cobb angles of C2 to C7, fusion rate, and graft subsidence , ACDF had more advantages.
Although almost single complication was similar between two groups, but in terms of number of total complications, ACDF produced more satisfactory efficacy. Further studies with high methodological quality and long-term follow-up periods are needed to evaluate the 2 procedures for mCSM treatment. The authors declare that they have no conflicts of interest regarding this study. National Center for Biotechnology Information , U. Journal List Medicine Baltimore v.
Medicine Baltimore. Published online Dec 9. Find articles by Wen-Yuan Ding. Author information Article notes Copyright and License information Disclaimer. Published by Wolters Kluwer Health, Inc. All rights reserved. This article has been cited by other articles in PMC. Results: A total of 8 studies containing patients were included in our study. Keywords: anterior cervical corpectomy and fusion, anterior cervical discectomy and fusion, clinical outcomes, multilevel cervical spondylotic myelopathy, radiographic outcomes, surgical outcomes.
Introduction Cervical spondylotic myelopathy CSM , a common clinical degenerative disease, seriously influences quality of life and even leads to disability for the old population. Materials and methods 2. Ethics statement There is no need to seek informed consent from patients, since this is a meta-analysis based on the published data, without any potential harm to the patients; this is approved by Ethics Committee of The Third Hospital of HeBei Medical University.
Inclusion criteria Studies were included if they met the following criteria: randomized or nonrandomized controlled study; age greater than or equal to 18 years; studies compared ACDF with ACCF for treatment of CSM; 3 or 4 levels cervical spondylotic myelopathy; follow-up more than 2 years.
Exclusion criteria Studies were excluded if they met the following criteria: dealt only with combined ACDF and ACCF surgery versus ACDF or ACCF alone for treatment of CSM; had an average follow-up time of less than 2 years; had repeated data; did not report outcomes of interest; in vitro human cadaveric biomechanical studies; earlier trial, reviews, and case-reports; have ossification of posterior longitudinal ligament.
Selection of studies Two reviewers independently reviewed all subjects, abstracts, and the full text of articles. Data extraction and management Two reviewers extracted data independently.
Statistical analysis We analyzed data by RevMan 5. Test for risk of publication bias Funnel plot as a visual inspection was used to assess publication bias. Results 3. Open in a separate window. Figure 1. Baseline characteristics and quality assessment In all, patients with mCSM from 8 studies were included in our study. Table 1 Characteristics of included studies. Clinical outcomes 3. Figure 2.
Figure 3. Figure 4. Figure 5. Figure 6. Radiographic outcomes 3. Figure 7. Figure 8. Figure 9. Figure Surgical outcomes 3. Discussion Recently, some studies [ 50 — 57 ] reported on the surgical plan for mCSM; however, as for mCSM, the option of surgical approach remains debated.
A clinical analysis of 4- and 6-year follow-up results after cervical disc replacement surgery using the Bryan Cervical Disc Prosthesis. J Neurosurg Spine ; 12 —9. Hybrid surgery of multilevel cervical degenerative disc disease: review of literature and clinical results. J Korean Neurosurg Soc ; 52 —8. Artificial disk replacement combined with midlevel ACDF versus multilevel fusion for cervical disk disease involving 3 levels.
Orthopedics ; 36 :e88— Is hybrid surgery of the cervical spine a good balance between fusion and arthroplasty? They happen when the body tries to repair itself by building extra bone.
The resulting spurs can drastically narrow your spinal canal, causing intense pain and pressure. The corpectomy can also be used to treat bone spurs sticking out from the edges of normal bone that make direct contact with nerves and other bones. The discectomy is most often used in the treatment of discs that have herniated. This means the disc has begun to slip, rupture, bulge or prolapse.
This occurs when the softer material inside begins trying to push through the much harder exterior. The doctors at Southeastern Spine Institute are highly knowledgeable, experienced and kind. The deep fascial layer and subcutaneous layers are closed with a few strong sutures. The skin can usually be closed using special surgical glue, leaving a minimal scar and requiring no bandage. The total surgery time is approximately 2 to 3 hours, depending on the number of spinal levels involved.
Most patients are able to go home days after surgery. Before patients go home, physical therapists and occupational therapists work with patients and instruct them on proper techniques of getting in and out of bed and walking independently. Patients are instructed to avoid bending and twisting of the neck in the acute postoperative period first weeks. Patients can gradually begin to bend and twist their neck after weeks as the pain subsides and the neck and back muscles get stronger.
Patients are also instructed to avoid heavy lifting in the acute postoperative period first weeks. Most patients are placed in a padded, plastic neck brace or cervicothoracic brace CTO. This reduces the stress on the neck area and helps decrease pain. It can also be used to improve bone healing by maintaining the neck in a rigid position, especially in the first few weeks and months after surgery.
The wound area can be left open to air. No bandages are required. Small surgical tapes affixing the suture should be left in place. The area should be kept clean and dry. Patients can shower immediately after surgery, but should keep the incision area covered with a bandage and tape, and try to avoid the water from water hitting directly over the surgical area.
After the shower, patients should remove the bandage, and dry off the surgical area. Patients should not take a bath until the wound has completely healed, which is usually around 2 weeks after surgery. Patients may begin driving when the pain has decreased to a mild level and mobility of the neck has improved, which is usually between weeks after surgery. Patients need to be able to turn their neck and body enough to see right and left while driving.
Patients should not drive while taking pain medicines narcotics. When driving for the first time after surgery, patients should make it a short drive only and have someone come with them, in case the pain flares up and they need help driving back home. After patients feel comfortable with a short drive, they can begin driving longer distances alone.
Patients may return to light work duties as early as weeks after surgery, depending on when the surgical pain has subsided.
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