A comparison of clinical and radiological outcomes following laminectomy and laminectomy with fusion in patients of cervical spondylotic myelopathy: A systematic review and meta-analysis.

Autor: Reddy DV; Department of Orthopedic Surgery, AIIMS (All India Institute of Medical Sciences) -Bibinagar, Hyderabad Metropolitan Region, Telangana, India., Satapathy D; Department of Orthopedic Surgery, AIIMS (All India Institute of Medical Sciences) -Bibinagar, Hyderabad Metropolitan Region, Telangana, India., Raja BS; All India Institute of Medical Sciences, Patna, India., Maley DK; Department of Orthopedic Surgery, AIIMS (All India Institute of Medical Sciences) -Bibinagar, Hyderabad Metropolitan Region, Telangana, India., Ahuja K; All India Institute of Medical Sciences, Rishikesh, India., Yalamanchili RK; Department of Orthopedic Surgery, AIIMS (All India Institute of Medical Sciences) -Bibinagar, Hyderabad Metropolitan Region, Telangana, India., Lakkireddy M; Department of Orthopedic Surgery, AIIMS (All India Institute of Medical Sciences) -Bibinagar, Hyderabad Metropolitan Region, Telangana, India., Ifthekar S; Department of Orthopedic Surgery, AIIMS (All India Institute of Medical Sciences) -Bibinagar, Hyderabad Metropolitan Region, Telangana, India. dr.syedifthekar@gmail.com.
Jazyk: angličtina
Zdroj: Neurosurgical review [Neurosurg Rev] 2024 Nov 20; Vol. 47 (1), pp. 861. Date of Electronic Publication: 2024 Nov 20.
DOI: 10.1007/s10143-024-03098-1
Abstrakt: To conduct a systematic review and meta-analysis comparing the functional and radiological outcomes in cervical spondylotic myelopathy (CSM) when treated by Laminectomy (LC) vs. laminectomy with instrumented fusion (LCF). The systematic review was conducted in accordance with PRISMA guidelines. A systematic electronic search was performed in PubMed, EMBASE, and CENTRAL databases. All Studies comparing clinical and radiological outcomes in patients with CSM when treated with LCF and LC were included in the systematic review. Neuromuscular function measured by modified Japanese orthopaedic association (mJOA), Cervical lordosis measured by C2-C7 Cobb's angle, and data on complications were retrieved from the studies. Random effect meta-analysis was used to account for heterogeneity. Quality assessment was performed using ROBINS-I and ROB-2 tools. Certainty of evidence was assessed using the GRADE working group recommendations. A total of 3985 articles were retrieved from the databases, of which 9 articles (1 RCT, 8 controlled comparative trials; n = 1146) met the eligibility criteria. The improvement in mJOA showed results favouring laminectomy with fusion with an SMD of 0.45 (95% CI, 0.07-0.84; p = 0.02). The loss of cervical lordosis was significantly lesser in the laminectomy with fusion group with an SMD of - 0.454 (95% CI, (- 0.12) - (- 0.79), p = 0.01). The complication rate in the LCF group was lower (LogOR = - 0.92; 95% CI: (- 1.30) - (- 0.55); p = < 0.05). In CSM, laminectomy with fusion is superior to standalone laminectomy in terms of improvement in m-JOA, maintenance of cervical lordosis and reduction in complications.
Competing Interests: Declarations Ethical approval Not applicable. The protocol for the systematic review was registered on PROSPERO (ID Number: CRD42024523083). Conflict of interest The authors of the systematic review have no conflict of interest.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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