Clinical Effectiveness And Safety Of Anterior Approach Versus Posterior Approach For Multilevel Cervical Spondylotic Myelopathy:a Meta-analysis

Objective:To assess the clinical effectiveness and Safety of Anterior approach versus posterior approach for multilevel cervical spondylotic myelopathy. Methods:The databases such as The Cochrane Library (Issue3,2013), PubMed (from1966to2013.3), OVID (from1950to2013.3), EMbase (from1966to2013.3), CBM’from1978to2013.3), WanFang Data (from1998to2013.3), CNK1(from1999to2013.3) were electronically searched and five relevant journals were handsearched to collect the randomized control trials(RCTs) or Non-randomized control trials about the clinical effectiveness and safety of anterior approach and posterior approach for multilevel cervical spondylotic myelopathy. Two reviewers independently screened the literature according to the inclusive and exclusive criteria, extracted the data, and assessed the methodological quality of included studies. Then the meta-analysis was performed by using RevMan5.2software. Results:A total of11control trials involving814patients were included. Meta-analysis showed that there were significant differences between the Anterior approach and Posterior approach in postoperative JOA scores [WMD-1.08,95%CI(0.68,1.47), P<0.00001], recovery of neural function of spinal cord [WMD=9.04,95%CI (4.13,13.94), P=0.0003], incidence of complications[OR=2.72,95%CI(1.76,4.19), P<0.00001], C5root palsy [OR=0.20,95%CI (0.06,0.64), P-0.007]. adjacent segments degeneration [OR=6.01,95%CI (1.47,24.54), P=0.01]. secondary surgical procedures[OR=3.90,95%CI(1.59,9.54), P=0.003], operation time [WMD=61.30,95%CI(52.33,70.28), P<0.00001] and intraoperative bleeding[WMD=150.02,95%CI(63.46,236.59), P=0.0007], However, there were no significant differences in the cervical range of motion [WMD=3.08,95%CI(-7.28,13.44), P= 0.56](P=0.56).Conclusion:Compared with posterior approach, anterior approach shows better postoperative JOA scores and recovery of neural function of spinal cord, lower incidence of C5root palsy. But posterior approach shows shorter operation time, lesser amount of intraoperative bleeding, lower incidence of adjacent segments degeneration, complications and secondary surgical procedures.